CROW Boot Coding Guidance

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  • September 10, 2009
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Noridian Administrative Services LLC (NAS) posted, Sept. 8, the following guidance on its policy for the Charcot Restraint Orthotic Walker.

The Charcot Restraint Orthotic Walker, also referred to as CROW boot or walker, was developed for patients with severe deformity of the foot and ankle due to a sensory neuropathic arthropathy — most commonly caused by diabetes. The device is a bi-valved copolymer full foot enclosure, totally encapsulated around the ankle and foot with a rocker bottom sole built into the device. The orthosis is custom fabricated to a positive model made from an impression of the patient’s affected limb. It is fully lined and uses a custom foot insert. Appropriate modifications are performed to the impression, which permits for equal weight distribution through the limb and provides support of the ankle joint, tibia, and fibula. The CROW boot can be modified to accommodate changes by flaring, adding padding, and trimming where and when appropriate.

Bill CROW boot services using the following HCPCS Level II codes:

L1960  Ankle foot orthosis, posterior solid ankle, plastic, custom-fabricated

L2232  Addition to lower extremity orthosis, rocker bottom for total contact ankle foot orthosis, for custom fabricated orthosis only

L2275  Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined

L2340  Addition to lower extremity, pre-tibial shell, molded to patient model

L2820  Addition to lower extremity orthosis, soft interface for molded plastic, below knee section

L3010  Foot, insert, removable, molded to patient model, longitudinal arch support, each

Noridian warns no other codes may be billed for a CROW boot; and there is no separate billing for any modifications, fitting, or adjustments.

When these products are used solely to treat edema or ulcers or to prevent an ulcer of the lower extremity, suppliers should code them based on the patient’s condition. HCPCS Level II code A9283 Foot pressure off loading/supportive device, any type, each was developed to describe various devices used for the treatment of edema or for a lower extremity ulcer or the prevention of ulcers. If the CROW boot is used for these conditions and the patient does not have Charcot arthropathy, then it should be coded A9283.

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