Medicare now differentiates between off-the-shelf and custom fitted type prefabricated AFOs including pneumatic and non-pneumatic walkers and plantar fascia night splints.
Traditionally used codes reflect the custom fitted version and the allowable amounts for both are currently the same. For devices traditionally billed using L4360, L4386 and L4396, new codes reflecting the off-the-shelf definition most likely apply.
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NEW BILLING CODES FOR PLANTAR FASCIA NIGHT SPLINTS, 150127
Medicare’s Pricing, Data Analysis and Coding (PDAC) has revised it’s original review of the Moore Balance Brace and determined the HCPCS codes to use for billing to be:
- L1940 – ankle foot orthosis, molded to patient, plastic
- L2820 – addition to lower extremity orthoss, soft interface for molded plastic, below knee section
- L2330 – addition to lower extremity orthosis, lacer molded to patient model, for custom fabricated orthoses only.
The 2012 maximum allowable fees for these codes are:
- L1940 $571.10
- L2820 $100.28
- L2330 $453.44
Medicare fees vary by state so go to www.dmepdac.com to determine the specific allowable amounts for your patients.
The Moore Balance Brace is commonly prescribed bilaterally to address risk factors contributory to increased risk of falling. Frequently determined diagnoses that might benefit from the stability afforded by the MBB include:
- Muscle weakness (728.87)
- Ataxia, muscular incoordination (781.3)
- Gait abnormality/ staggering, ataxic (781.2)
- Osteoarthritis, localized primary ankle & foot (715.17)
- Arthropathy, unspecified, ankle and foot (716.97)
- Pain in joint, ankle, foot (719.47)
- Instability of joint, ankle & foot (718.87)
- Dropfoot (736.79)
- Hemiplegia (438.20)
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For additional information about the Moore Balance Brace and fall prevention please contact SafeStep at 866.712.STEP (7837) or email email@example.com.
PDAC Certification Letter