Medicare recently announced that the design of an L1906, multi ligamentous ankle support must “include a rigid stirrup and foot plate which provides functional tracking of the ankle with hind-foot and mid-foot stability during ambulation” and that devices that meet the description are now required to have a PDAC verification letter. See the full descriptions below:
We have received updated HCPCS Coding Verification letters on both the Swede-O Arch Lok and Atom Hinged Ankle braces.
Notifications on other devices in this category will be forthcoming as they become available.
Until March 31, 2012, a PDAC verification letter has not been required for a device to qualify for Medicare reimbursement. It has simply been necessary that the device meet the description described below:
L1906 ANKLE FOOT ORTHOSIS, MULTILIGAMENTOUS ANKLE SUPPORT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
A multiligamentous ankle support provides control of the ankle joint between the medial and lateral malleoli while allowing for dorsiflexion and plantar flexion. This off-the-shelf ankle support includes a rigid stirrup and foot plate which provides functional tracking of the ankle with hind-foot and mid-foot stability during ambulation. This, in conjunction with wrap-around straps and the inherent gauntlet design, offers areas of multiligamentous support as described by the code. There are no additional HCPCS codes for this type of prefabricated ankle orthosis.
Additionally, Medicare said
Effective for claims with dates of service on or after April 1, 2012, the only products which may be billed to Medicare using code L1906 (ANKLE FOOT ORTHOSIS, MULTILIGAMENTUS ANKLE SUPPORT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT) are those for which a written coding verification has been made by the Pricing, Data Analysis, and Coding (PDAC) contractor and that are listed in the Product Classification Matrix of the DME Coding System (DMECS). Products which have not received coding verification review from the PDAC must be billed with code A9270. Please refer to the advisory article titled Coding Guidelines for Ankle Foot Orthoses.
Products that are currently listed on DMECS with L1906 will be end dated effective March 31, 2012 and changed to A9270 until a coding verification review has been completed by the PDAC.
Thus, it is mandatory that manufacturers submit to PDAC devices for L1906 verification in order for them to qualify for reimbursement.
There are some multi ligamentous type devices that have been recommended to be billed using L1906 code such as the Ossur Exoform and the GameDay that do not have a foot plate. As such they would need to be billed as A9270. They might more appropriately meet the description of L1902. See description below:
L1902 ANKLE FOOT ORTHOSIS, ANKLE GAUNTLET, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
The Donjoy Velocity (and Ossur Rebound) are recommended by the manufacturers to be billed using code L1971. This is based on the description below:
L1971 ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL WITH ANKLE JOINT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
For a complete list of products that are currently listed on PDAC site with L1906 code see the link below:
In summary, the new ruling affects items billed using L1906 not L1971. Some items currently filed as L1906 will need to be reclassified as L1902. All items that meet new definition of L1906 will need a verification letter starting April 1, 2012.