HCPCS Code L0430 - Invalid

Effective for dates of service on or after November 17, 2012, Healthcare Common Procedure Coding System (HCPCS) code L0430 (SPINAL ORTHOSIS, ANTERIOR-POSTERIOR-LATERAL CONTROL, WITH INTERFACE MATERIAL, CUSTOM FITTED (DEWALL POSTURE PROTECTOR ONLY)) will be invalid for claim submission to the Durable Medical Equipment Medicare Administrative Contractors (DME MACs).

Products previously coded L0430 by the Pricing, Data Analysis and Coding (PDAC) contractor and posted to the Durable Medical Equipment Coding System (DMECS) will be end dated on November 17, 2012. DMECS can be accessed by selecting on the following link, https://www.dmepdac.com/dmecsapp/.

Manufacturers, distributors or suppliers previously billing for L0430 should submit a Coding Verification Review Application to the PDAC to determine the correct billing code.

The PDAC coding verification review application required for these products is the Orthotics application. This application is located on the PDAC website at https://www.dmepdac.com/review/apps_check.html.

If you have questions, please contact the 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, https://www.dmepdac.com/.

Refer to the Spinal Orthosis: TLSO and LSO Local Coverage Determination (LCD) and Policy Articles (PA) for additional coverage, coding and documentation requirements.