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

Phone: 305.436.5030
Fax: 305.436.0086
Email Address: email info jcr_safe_email_at_this_domain

2011-01 A19885 Local Coverage Article for Ankle-Foot/Knee-Ankle-Foot Orthosis

Local Coverage Article for Ankle-Foot/Knee-Ankle-Foot Orthosis – Policy Article – Effective January 2011 (A19885)

18003 Contractor Type DME MAC

Other Information
Revision History Explanation
Revision Effective Date: 01/01/2011
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: Preamble language
Revised: Clarified noncoverage statements for L4392, L4394, L4396 and L4398
CODING GUIDELINES:
Added: Definition of L4631
Revised: Clarified proper coding instructions based on brace use
Revision Effective Date: 01/01/2010
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: Information on code A4466
CODING GUIDELINES:
Deleted: Reference to invalid code L2770

Revision Effective Date: 12/01/2009
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: Information on code A9283
CODING GUIDELINES:
Revised: Instructions for coding A9283
Revised: Instructions for code L2770
Revised: Instructions for coding concentric adjustable torsion joints
Revised: Instructions for RT/LT modifiers

Revision Effective Date: 06/01/2009
CODING GUIDELINES:
Deleted: Code L2035 from the custom-fabricated orthoses list
Deleted: Codes K0628 and K0629 from the list used in diabetic foot problems management
Added: Codes A5512 and A5513 to the list used in diabetic foot problems management
Added: Code L4392 to list of codes rejected as incorrect coding when billed with initial issue of a base orthosis.

Revision Effective Date: 04/01/2009
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: Noncoverage language for elastic support garments
CODING GUIDELINES:
Deleted: Code L1901 from the prefabricated orthoses list and from the from ankle-foot orthosis worn by ambulatory patients.
Added: Code L2770 is invalid for dates of service (DOS) on or after 07/01/2008
Revised: Removed Column I/Column II table in lieu of statement about billing replacement codes at time of initial issue.
Revised: SADMERC to PDAC

03/01/200 – In accordance with Section 911 of the Medicare Modernization Act, this policy was transitioned to DME MAC CIGNA Government Services (18003) Article A19885 from DME PSC TrustSolutions (77012) Article A19885.

Revision Effective Date: 01/01/2008
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: Noncoverage statement regarding A9283.
CODING GUIDELINES:
Added: Definition of A9283

Revision Effective Date: 07/01/2007
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Changed title of previous Therapeutic Shoes for Diabetics LMRP, to the new LCD title – Therapeutic Shoes for Persons with Diabetes.
CODING GUIDELINES:
Changed title of previous Therapeutic Shoes for Diabetics LMRP, to the new LCD title – Therapeutic Shoes for Persons with Diabetes.
Removed: Reference to DMERC.

06/01/2007 – In accordance with Section 911 of the Medicare Modernization Act of 2003, Virginia and West Virginia were transitioned from DME PSC TriCenturion (77011) to DME PSC TrustSolutions (77012).

03/01/2006 – In accordance with Section 911 of the Medicare Modernization Act of 2003, this article was transitioned to DME PSC TrustSolutions (77012) from DMERC Palmetto GBA (00885).

Revision Effective Date: 01/01/2006
CODING GUIDELINES:
Added: L2034
Deleted L2039

Revision Effective Date: 04/01/2005
HCPCS CODES AND MODIFIERS:
Added: L2005, L2232, L4002
Revised: L2035, L2036, L2037, L2038, L2039, L2320, L2330, L2755, L2800, L4040, L4045, L4050, L4055
Deleted: L2435

Revision Effective Date: 07/01/2004
LMRP converted to LCD and Policy Article
Coding Guidelines: Revised definition of L4396 to include use in the treatment of plantar fasciitis.

Related Document(s)
LCD
L11517 – Ankle-Foot/Knee-Ankle-Foot Orthosis opens in new window