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Coverage Position Number: 0362
According to the American Academy of Orthopaedic Surgeons (AAOS) (2003), there are four basic kinds of knee braces:
- prophylactic braces, which are designed to prevent or reduce the severity of knee injury
• functional braces, which are designed to (a) provide stability for the anterior-cruciate ligament (ACL) or other ligament deficiency of the knee and (b) provide protection for the ACL or other ligaments after repairs or reconstructions - rehabilitative braces, which are designed to allow protected motion of injured knees or knees that have been treated operatively
- unloader/offloader braces, which are designed to provide pain relief in arthritic knees
Another less commonly utilized knee brace is a fracture brace (Healthcare Common Procedure Coding System [HCPCS] code L2126). This type of brace has been employed for the treatment of tibial-femoral fractures and may be custom-made or prefabricated. It is a functional brace that is applied after initial stabilization. It allows protected weightbearing and motion of the joints above and below the fracture. A review of the literature suggests this brace allows early joint movement, prevention of contractures, and early weightbearing, resulting in early healing.
Knee sleeves, also known as patellofemoral knee braces, are elastic sleeves used to provide a feeling of support to the knee. These devices are intended to resist lateral displacement of the patella and thereby decrease knee pain. Most authors agree that the effectiveness of knee bracing is controversial for the treatment of patellofemoral pain syndrome (France and Paulos, 1994; Paluska and McKeag, 2000; LaBella, 2004). Plain knee sleeves may be used to treat postoperative knee effusions and patellofemoral pain syndrome, although clinical efficacy is not well established. The sleeve may be modified to include an opening for the patella, movable straps or a buttress and to function as a counterforce brace for the treatment of joint disorders, such as dislocation, patellar subluxation or patellar hypermobility. Patellofemoral knee braces include devices such as Bledsoe Sport Max (Bledsoe Brace Systems, Grande Prairie, TX) and Lateral knee stabilizer with “J” shaped buttress (FLA Orthopedics®, Inc., Miramar, Fl).
Some authors have reported decreased pain and improved function with use of these braces; however, in these studies, rehabilitative treatments have been provided at the same time. Most reported patient outcomes are subjective reports of pain relief. Furthermore, the American Academy of Pediatrics (AAP, 2001) states that knee sleeves do not provide ligamentous support and are considered insufficient for the treatment of an unstable knee. France and Paulos (1994) also report that knee braces used for the treatment of patellofemoral pain resulting from chondromalacia or osteoarthritis without hypermobility are not considered effective. Nonetheless, when combined with a rehabilitation program, patellar bracing can be used to prevent recurrent patellar subluxation and dislocations (Phillips, 2003).
Knee braces may be either custom fabricated or prefabricated (“off the shelf”). Custom-fabricated braces (HCPCS codes L1834, L1840, L1844, L1846 and L1855-L1880) are those that require precise measurements or molds/casting of the patient’s knee and may only be used by the individual patient. Prefabricated braces (HCPCS codes L1800-L1832, L1836, L1843, L1845, L1847 and L1850) may be purchased off the shelf in stores. Patients may be fitted for prefabricated (custom-fitted) braces, and require adjustments by an orthotist; however, selection is limited by the limited availability of popular sizes (e.g., small, medium, large). A review of the published scientific literature does not indicate that custom-fabricated knee braces are more effective than prefabricated or custom-fitted braces. Custom-fabricated knee braces are only medically necessary when a prefabricated brace cannot be used as a result of abnormal limb structure or knee deformity, or for an extreme deviation from average sizes.
Some additions to knee braces are included in the base code of the brace and are not separately reimbursable. Additions to knee braces will not be covered if the base code is not medically necessary or the specific addition is not medically necessary. Braces requiring high-strength, lightweight material (HCPCS code L2755) may be covered for patients who meet the requirements for a knee brace and who either work in an environment requiring a brace designed for high-impact/high-stress activities or for