Concentric Adjustable Torsion Joints – Correct Coding

Based on a benefit category determination from the Centers for Medicare & Medicaid Services (CMS), the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) are revising the Knee Orthosis (KO) and Ankle-Foot Orthosis (AFO) / Knee-Ankle-Foot Orthosis (KAFO) policy articles.  The revision includes information about the proper coding of concentric adjustable torsion-style mechanisms incorporated into orthotics.

The distinction in coding relates to the indicated use of the joint and the beneficiary’s medical condition(s). Concentric adjustable torsion-style joints used solely to provide an assistive function for joint motion must be coded L2999 or L3999.  When concentric adjustable torsion-style joints are used for any condition other than to provide an assistive function for joint motion, they must be coded as durable medical equipment using the following codes:

E1800 – Dynamic adjustable elbow extension/flexion device

E1802 – Dynamic adjustable forearm pronation/supination device

E1805 – Dynamic adjustable wrist extension/flexion device

E1810 – Dynamic adjustable knee extension/flexion device

E1815 – Dynamic adjustable ankle extension/flexion device

The effective date of the Local Coverage Determination (LCD) and related policy article revision for the concentric adjustable torsion-style mechanisms will be for claims with dates of service on or after March 13, 2012.  The remainder of the LCD and related policy article revisions will be effective for dates of service on or after July 1, 2012.

Suppliers of these products are strongly encouraged to read the KO and AFO/KAFO LCDs and related policy articles for additional information on coverage, coding and documentation.