Code Knee Orthoses Right to Get Braces Paid
- By Brad Ericson
- In Billing
- May 8, 2018
- Comments Off on Code Knee Orthoses Right to Get Braces Paid

Knee orthoses are one of the highest sources of errors, a letter from CGS to providers warns, and the Medicare Administrative Contractor’s (MAC) wants providers to be more careful with documentation and reporting.
How Do We Get Paid?
The Centers for Medicare & Medicaid Services (CMS) requires medical necessity for the diagnosis or treatment of the body part. According to Social Security Act, orthoses must be a rigid or semi-rigid device, be used to supporting a weak or deformed body member, or eliminating motion in a diseased or injured body part to recognize the Medicare Braces Benefit. That means to receive reimbursement, the item must be rigid enough to permit demobilization and support the body part. For each type of orthosis, medical necessity is specific to that body part.
CGS also advises providers that while custom fabricated knee orthoses have the same basic coverage criteria as teh same type of prefabricated knee orthosis, there must be documentation in the records medically describing why the patient needs a custom fabricated device instead of a prefabricated orthosis. Examples of this include these reasons:
- Deformity of the leg or knee
- Size of the patient’s thigh and calf
- Minimal muscle mass upon which to suspend the orthosis
This is important for the following codes:
L1810 Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L1812 Knee orthosis, elastic with joints, prefabricated, off-the-shelf
L1820 Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, includes fitting and adjustment
L1830 Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf
L1831 Knee orthosis, locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment
L1832 Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L1833 Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf
L1834 Knee orthosis, without knee joint, rigid, custom fabricated
L1836 Knee orthosis, rigid, without joint(s), includes soft interface material, prefabricated, off-the-shelf
L1840 Knee orthosis, derotation, medial-lateral, anterior cruciate ligament, custom fabricated
L1843 Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L1844 Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated
L1845 Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L1846 Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated
L1847 Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L1848 Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated, off-the-shelf
L1850 Knee orthosis, swedish type, prefabricated, off-the-shelf
L1851 Knee orthosis (ko), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf
L1852 Knee orthosis (ko), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf
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