LEEDer Group Inc.
8508 North West 66th St.
Miami, Florida 33166 USA

Phone Toll-free: 866.814.0192 or 305.436.5030
Fax Toll-free: 866.818.0373 or 305.436.0086
E-mail Address: orders {at] LEEDerGroup [dot] com

2011-03 Billing Reminder for Knee Orthoses Addition Codes

March 16, 2011

Billing Reminder for Knee Orthoses Addition Codes
  • Recent reviews performed by the Recovery Audit Contractors (RACs) identified errors in the billing of additions to knee orthoses. NHIC, Jurisdiction A DME MAC, is providing the following information for suppliers to avoid claim denials for inappropriate billing of knee orthoses addition codes.
  • The Knee Orthoses Local Coverage Determination (LCD) indicates which addition codes are separately payable when they are provided with a related base code orthoses.
  • Suppliers are responsible for ensuring that the base code and addition code are compatible and considered reasonable and necessary according to policy.
  • Addition codes will be denied as not reasonable and necessary if the base orthosis or the addition is not reasonable and necessary.
  • Prefabricated Knee Orthoses:
    The table below provides a list of knee orthoses base codes and the addition codes that are considered as appropriate for use with a given base orthosis.
  • Base Code Addition Codes > Eligible for Separate Payment
    L1810 > None
    L1820 > None
    L1830 > None
    L1831 > None
    L1832 > L2397 (suspension sleeve), L2795 (off set knee joint Hvy Duty), L2810 (condylar control pad)
    L1836 > None
    L1843 > L2385, L2395, L2397
    L1845 > L2385, L2395, L2397, L2795
    L1847 > None
    L1850 > L2397
  • The table below lists addition codes that describe components or features that can be physically incorporated in the specified prefabricated base orthosis but are considered not reasonable and necessary. Although the additions may be physically incorporated to the base, if they are billed with the related base code, they will be denied as not reasonable and necessary.
  • Base Code Addition Codes > Not Reasonable and Necessary
    L1810 > L2397
    L1820 > L2397
    L1830 > L2397
    L1831 > L2397, L2795
    L1832 > L2405 (joint drop lock, ea.), L2415 (joint cam lock, ea.), L2492 (lift loop drop lock ring), L2785 (drop lock retainer, ea.)
    L1836 > L2397
    L1843 > L2405, L2492, L2785
    L1845 > L2405, L2415, L2492, L2785
    L1847 > L2397, L2795
    L1850 > L2275
  • The following table lists addition codes that describe components or features that can be physically incorporated in the specified prefabricated bases orthosis but are considered included in the allowance for the orthosis. The addition codes will be denied as not separately payable if they are billed with the related base code.
  • Base Code Addition Codes > Not Separately Payable
    L1834 > K0672, L2820, L2830, L4002
    L1840 > K0672, L2320, L2330, L2750, L2780, L2810, L2820, L2830, L4002
    L1844 > K0672, L2275, L2320, L2330, L2425, L2430, L2750, L2780, L2810, L2820, L2830, L4002
    L1846 > K0672, L2275, L2320, L2330, L2425, L2430, L2750, L2780, L2810, L2820, L2830, L4002
    L1860 > K0672, L2820, L2830, L4002
  • Custom Fabricated Knee Orthoses:
    These same rules apply to custom fabricated knee orthoses. The addition codes will be denied as not reasonable and necessary if the base orthosis or the addition is not reasonable and necessary. The table below identifies the base and addition codes that are eligible for separate payment.
  • Base Code Addition Codes > Eligible for Separate Payment
    L1834 > L2795
    L1840 > L2385, L2390, L2395, L2397, L2405, L2415, L2425, L2430, L2492, L2785, L2795
    L1844 > L2385, L2390, L2395, L2397, L2405, L2492, L2785
    L1846 > L2385, L2390, L2395, L2397, L2405, L2415, L2492, L2785, L2795, L2800
    L1860 > None
  • The following table lists addition codes that describe components or features that can be physically incorporated in the specified custom fabricated base orthosis but are considered not reasonable and necessary. These addition codes, if they are billed with the related base code, will be denied as not reasonable and necessary.
  • Base Code Addition Codes > Not Reasonable and Necessary
    L1834 > L2397, L2800
    L1840 > L2275, L2800
    L1844 > None
    L1846 > None
    L1860 > L2397
  • The following table lists addition codes that describe components or features that can be physically incorporated in the specified custom fabricated bases orthosis but that are considered included in the allowance for the orthosis. The addition codes will be denied as not separately payable if they are billed with the related base code.
  • Base Code Addition Codes > Not Separately Payable
    L1834 > K0672, L2820, L2830,L4002
    L1840 > K0672, L2320, L2330, L2750, L2780, L2810, L2820, L2830,L4002
    L1844 > K0672, L2275, L2320, L2330, L2425, L2430, L2750, L2780, L2810, L2820, L2830,L4002
    L1846 > K0672, L2275, L2320, L2330, L2425, L2430, L2750, L2780, L2810, L2820, L2830,L4002
    L1860 > K0672, L2820, L2830,L4002
  • Addition codes that are not listed as either separately payable or not medically necessary in the LCD describe components or features that either cannot be physically incorporated or whose narrative description is incompatible with the specified base orthosis code (e.g., billing a prefabricated base code with an addition code which specifies that the addition code it is only used with custom fabricated orthoses). These incompatible addition codes will be rejected as incorrect coding. Suppliers may resubmit their claim with the appropriate addition code when applicable. As a reminder, appeal rights are not afforded on claims rejected due to incorrect coding.