Last updated on 4/11/18 | First published on 11/18/17 | Literature review current through Mar. 2024
[cite]
CODING, COVERAGE AND REIMBURSEMENT
General
LCD: https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33686&ContrID=140
Policy Article: https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=52457&ContrID=140
Walking boots
- HCPCS:
- Coverage requirements:
- Frequency of replacement allowed by Medicare:
-
- Non-covered conditions:
A foot pressure off-loading/supportive device (A9283) is denied as noncovered (no Medicare benefit), because it does not support a weak or deformed body member or restrict or eliminate motion in a diseased or injured part of the body.
Static/dynamic Ankle-Foot Orthosis
- HCPCS:
- L4396 or L4397 is covered, a replacement interface (L4392)
- Coverage requirements:
- Frequency of replacement allowed by Medicare:
- If code L4396 or L4397 is covered, a replacement interface (L4392) is covered as long as the beneficiary continues to meet indications and other coverage rules for the splint. Coverage of a replacement interface is limited to a maximum of one (1) per 6 months. Additional interfaces will be denied as not reasonable and necessary.
- Non-covered conditions:
- A static/dynamic Ankle-Foot Orthosis (AFO) (L4396, L4397) and replacement interface (L4392) are denied as noncovered (no Medicare benefit) when they are used solely for the prevention or treatment of a heel pressure ulcer because for these indications they are not used to support a weak or deformed body member or to restrict or eliminate motion in a diseased or injured part of the body (i.e., it does not meet the definition of a brace).
- Billing reminders:
Foot drop splint/ recumbent positioning device
- Medicare does not reimburse for a foot drop splint/recumbent positioning device (L4398) or replacement interface (L4394)
Official reprint from WoundReference® woundreference.com ©2024 Wound Reference, Inc. All Rights Reserved
Use of WoundReference is subject to the
Subscription and License Agreement.
NOTE: This is a controlled document. This document is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.
CODING, COVERAGE AND REIMBURSEMENT
This section currently focuses primarily on Medicare. It may be expanded in the future to include information on private insurers as well.GeneralOverall, . These items are only covered if used at the beneficiary's residence (place of service 12) and are not separately payab
CODING, COVERAGE AND REIMBURSEMENT
This section currently focuses primarily on Medicare. It may be expanded in the future to include information on private insurers as well.GeneralOverall, Canes and Crutches are covered under the Durable Medical Equipment benefit (Social Security Act §1861(s)(6)) = place of
