Ankle-Foot Orthoses: Walking Boots - Coverage and Coding Issues - Revised
Ankle-Foot Orthoses: Walking Boots – Coverage and Coding Issues – Revised
Revised July 10, 2014 (O&P)
Posted March 2004
Effective: August 1, 2014
- HCPCS codes L4360, L4361, L4386 and L4387 describe an ankle-foot orthosis commonly referred to as a walking boot. Walking boots that are used to provide immobilization as treatment for an orthopedic condition or following orthopedic surgery are eligible for coverage under the Brace benefit. When walking boots are used primarily to relieve pressure, especially on the sole of the foot, or are used for patients with foot ulcers, they are noncovered – no benefit category. Medicare covers therapeutic shoes, as described in the Therapeutic Shoes for Persons with Diabetes local coverage determination (LCD), for the prevention and treatment of diabetic foot ulcers.
- Suppliers must add a GY modifier to HCPCS code L4360, L4361, L4386 or L4387 if the walking boot is only being used for the treatment or prevention of a foot ulcer. The absence of a GY modifier indicates that the walking boot is being used as part of the treatment for an orthopedic condition or following orthopedic surgery. Claims for HCPCS code L4360, L4361, L4386 or L4387 with a GY modifier will be denied as noncovered.
- Prefabricated walking boots must be billed with HCPCS codes L4360, L4361, L4386 or L4387. Add-on codes must not be billed in addition to these HCPCS codes. Custom fabricated walking boots must be billed with HCPCS code L2999 and must be accompanied by information identifying the manufacturer and model name (if applicable), the indication(s) for use of the boot, and an explanation of why a prefabricated walking boot is not sufficient. Walking boots must not be billed with other AFO HCPCS codes, including but not limited to HCPCS codes L2106-L2116, or with HCPCS codes for therapeutic shoes.
- For questions about correct coding, contact the Pricing, Data Analysis, and Coding (PDAC) Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form located on the PDAC website