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compartments and patellofemoral joint disease has not been successfully treated with braces (Pruitt, 2005).
Angular deformities of the joint can lead to focal overload and predisposition to osteoarthritis. Varus deformities cause overload to the medial compartment, while valgus deformities cause overload to the lateral compartment. Knee braces with varus or valgus adjustments (HCPCS code L1843) may be medically necessary for patients who are ambulatory and require bracing to alleviate pressure on the medial or lateral compartment of the knee.
Research on the outcomes of using unloading braces reveals decreased pain in patients who have osteoarthritis. Matsuno et al. (1997) reported on the clinical efficacy of the Generation II knee brace in patients with severe medial compartment osteoarthritis. In a case series of 20 patients, the authors reported significant pain relief in 19 of the 20 patients, improvement in knee pain scores from 18.0 to 21.5, and increased quadriceps muscle strength in all patients. Kirkley and colleagues (1999) published results of a randomized, controlled trial involving 119 patients with varus gonarthrosis (varus deformity of the knee). The patients were randomly assigned to one of three groups: medical treatment only, medical treatment and the use of a neoprene sleeve, or medical treatment and use of a Generation II unloader brace. The results of the study indicated that patients with varus gonarthrosis may benefit from the use of a knee brace in addition to standard treatment and that the unloader knee brace was, on average, more effective than the neoprene sleeve.
Summary
Knee braces are considered useful in the treatment of knee injuries and disease. On the basis of current clinical knowledge, the use of rehabilitative knee braces and unloading braces has been well accepted. Prophylactic knee braces are most often recommended for participation in sports or recreational activities and are not considered medically necessary. Fracture braces are recommended in some cases and are likely to encourage osteogenesis. Functional knee braces have not been shown to improve long-term patient outcomes and are not considered medically necessary. Patellofemoral braces have been recommended for a select group of patients. Typically, prefabricated orthoses are used in treating conditions prior to the use of a custom-fitted orthosis, and custom-fitted orthoses are generally attempted prior to the use of custom-fabricated orthoses when clinically appropriate.
Coding/Billing Information
Note: This list of codes may not be all-inclusive.
Covered when medically necessary:
HCPCS Codes
Description
L1800
KO, elastic with stays, prefabricated, includes fitting and adjustment
L1810
KO, elastic with joints, prefabricated, includes fitting and adjustment
L1815
KO, elastic or other elastic type material with condylar pad(s), prefabricated, includes fitting and adjustment
L1820
KO, elastic with condylar pads and joints, with or without patellar control, prefabricated, includes fitting and adjustment
L1825
KO, elastic knee cap, prefabricated, includes fitting and adjustment
L1830
KO, immobilizer, canvas longitudinal, prefabricated, includes fitting and adjustment
L1831
Knee orthosis, locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment
L1832
KO, adjustable knee joints, positional orthosis, rigid support, prefabricated, includes fitting and adjustment
L1834
KO, without knee joint, rigid, custom fabricated
L1836
Knee orthosis, rigid, without joint(s), includes soft interface material, prefabricated, includes fitting and adjustment
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L1840
KO, derotation, medial-lateral, anterior cruciate ligament, custom fabricated
L1843
Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint, medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, includes fitting and adjustment
L1844
Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint, medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated
L1845
KO, double upright, thigh and calf, with adjustable flexion and extension joint, medial-lateral and rotation control, prefabricated, includes fitting and adjustment
L1846
KO, double upright, thigh and calf, with adjustable flexion and extension joint, medial-lateral and rotation control, custom fabricated
L1847
KO, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated, includes fitting and adjustment
L1850
KO, Swedish type, prefabricated, includes fitting and adjustment
L1855
KO, molded plastic, thigh and calf sections, with double upright knee joints, custom fabricated
L1858
KO, molded plastic, polycentric knee joints, pneumatic knee pads (CTI), custom fabricated
L1860
KO, modification of supracondylar prosthetic socket, custom fabricated (SK)
L1870
KO, double upright, thigh and calf lacers, with knee joints, custom fabricated
L1880
KO, double upright, nonmolded thigh and calf cuffs/lacers with knee joints, custom fabricated
L2275
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined
ICD-9-CM Diagnosis Codes
Description
715.10
Primary localized osteoarthrosis, specified site
715.16
Primary localized osteoarthrosis, lower leg
715.18
Primary localized osteoarthrosis, other specified sites
715.26
Secondary localized osteoarthrosis, lower leg
715.28
Secondary localized osteoarthrosis, other specified site
715.36
Localized osteoarthrosis not specified whether primary or secondary, lower leg
715.38
Localized osteoarthrosis not specified whether primary or secondary, other specified sites
715.96
Osteoarthrosis, unspecified whether generalized or localized, lower leg
717.0
Old bucket handle tear of medial meniscus
717.1
Derangement of anterior horn of medial meniscus
717.2
Derangement of posterior horn of medial meniscus
717.40
Unspecified derangement of lateral meniscus
717.41
Bucket handle tear of lateral meniscus
717.42
Derangement of anterior horn of lateral meniscus
717.43
Derangement of posterior horn of lateral meniscus
733.16
Pathologic fracture of tibia and fibula
733.93
Stress fracture of tibia or fibula
823.00
Closed fracture of upper end of tibia
823.02
Closed fracture of upper end of fibula with tibia
823.10
Open fracture of upper end of tibia
823.12
Open fracture of upper end of fibula with tibia
836.0
Tear of medial cartilage or meniscus of knee, current
836.1
Tear of lateral cartilage or meniscus of knee, current
836.3
Closed dislocation of patella
836.4
Open dislocation of patella
836.50
Closed dislocation of knee, unspecified part
836.51
Closed anterior dislocation of tibia, proximal end
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836.52
Closed posterior dislocation of tibia, proximal end
836.53
Closed medial dislocation of tibia, proximal end
836.54
Closed lateral dislocation of tibia, proximal end
836.60
Open dislocation of knee unspecified part
836.61
Open anterior dislocation of tibia, proximal end
836.62
Open posterior dislocation of tibia, proximal end
836.63
Open medial dislocation of tibia, proximal end
836.64
Open lateral dislocation of tibia, proximal end
844.0
Sprain and strain of lateral collateral ligament of knee
844.1
Sprain and strain of medial collateral ligament of knee
844.2
Sprain and strain of cruciate ligament of knee
844.3
Sprain and strain of tibiofibular (joint) (ligament) superior, of knee
844.8
Sprain and strain of other specified sites of knee and leg
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