Medicare’s Pricing, Data Analysis and Coding (PDAC) has determined that the HCPCS codes to use when billing the Moore Balance Brace are :
- L1940 – ankle foot orthosis, molded to patient, plastic
- L2820 – addition to lower extremity orthoses, soft interface for molded plastic, below knee section
The 2012 maximum allowable fees for these codes are:
- L1940 $571.10
- L2820 $100.28
The Moore Balance Brace is commonly prescribed bilaterally to address risk factors contributory to increased risk of falling.
Frequently determined diagnoses related to increased risk for falling 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)
Arizona AFO, the manufacturer of the Moore Balance Brace believes that like it’s other gauntlet devices, the MBB should also be verified for HCPCS code L2330, with the comment, “used whether the closure is a lacer closure or a Velcro closure” and has scheduled an in-person appeal in Fargo, ND in April.
Suppliers are advised that until the PDAC reconsiders the verification determination that only codes L1940 and L2820 be used for billing purposes.
For additional information about the Moore Balance Brace or fall prevention please see the SafeStep forum (safestepforum.net), blog (safestepblog.net) or contact SafeStep at 866.712.STEP (7837) or email firstname.lastname@example.org.