Part B Insider (Multispecialty) Coding Alert

Published on Mon Aug 18, 2014 PDF

Plus: This MAC clarifies modifier 22 submissions.

If you simply can’t wait until Jan. 1 to access new codes, CMS has a gift for you, with two new orthotics codes that you can use effective Oct. 14. The new codes for prefabricated knee orthoses were published in CMS Transmittal 3016, which was issued on Aug. 8, and are as follows:

• K0901: 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
• K0902: 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

These new codes are payable as leg braces, which are defined as “Rigid or semi-rigid devices which are used for the purpose of supporting a weak or deformed body member or restricting or eliminating motion in a diseased or injured part of the body,” CMS explains in the Transmittal.

To read Transmittal 3016, visit www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3016CP.pdf.