Is L4396 covered 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. Medicare does not reimburse for a foot drop splint/recumbent positioning device (L4398) or replacement interface (L4394).

Are Afos covered by Medicare?

Ankle-foot orthoses (AFO) and knee-ankle foot orthoses (KAFO) are covered under the Medicare Braces Benefit (Social Security Act §1861(s)(9)). Both “off-the-shelf” (OTS) and custom-fit items are considered prefabricated braces for Medicare coding purposes.

What is L1932 for?

L1932 (AFO, RIGID ANTERIOR TIBIAL SECTION, TOTAL CARBON FIBER OR EQUAL MATERIAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT) describes a prefabricated Ankle Foot Orthosis designed to control the dorsiflexion and plantarflexion, and inversion and eversion, motions of the ankle foot complex.

Does L1902 need a modifier?

Response: L1902 is covered if your medical necessity documentation conforms with that listed in the LCD. From a coding perspective, you must use the “KX” modifier (use of this stipulates you have the met documentation requirement in the LCD), and either an “RT” or “LT” modifier.

What is CPT code L1970?

L1970: ANKLE FOOT ORTHOSIS, PLASTIC WITH ANKLE JOINT, CUSTOM-FABRICATED.

How often should Afos be replaced?

As he notes, children usually outgrow their devices approximately every two years or two shoe sizes with a range of one to three years. He points out that as the child gets older, growth slows so replacement is not necessary as often.

How often will Medicare pay for a back brace?

How often will Medicare pay for a back brace ? Typically, a back brace which is worn out can be replaced every five years, as long as it has been in the beneficiary’s possession for that whole period.

What is CPT L4386?

Short Description: Non-pneum walk boot prefab. Long Description: WALKING BOOT, NON-PNEUMATIC, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, PREFABRICATED ITEM THAT HAS BEEN TRIMMED, BENT, MOLDED, ASSEMBLED, OR OTHERWISE CUSTOMIZED TO FIT A SPECIFIC PATIENT BY AN INDIVIDUAL WITH EXPERTISE.

What does the KX modifier stand for?

The KX modifier, described in subsection D., is added to claim lines to indicate that the clinician attests that services at and above the therapy caps are medically necessary and justification is documented in the medical record.

Is the KX modifier only for Medicare?

Therapists should continue to affix the KX modifier to all medically necessary services above the designated limit ($2,010 in 2018), thus signaling Medicare to pay the claim. That means you must continue to track your patients’ progress toward the threshold so you know when to affix the modifier.

What does a 59 modifier mean?

procedures/services
Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used.

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