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Ankle-Foot/Knee-Ankle-Foot Orthoses
MA05.010g


Policy

MEDICALLY NECESSARY

ANKLE-FOOT ORTHOSES AND KNEE-ANKLE-FOOT ORTHOSES USED DURING AMBULATION
Ankle-Foot Orthoses (AFOs)

AFOs (L1900, L1902-L1990, L2106-L2116, L4350, L4360, L4361, L4386, L4387 L4631) are considered medically necessary and, therefore, covered for ambulatory individuals with weakness or deformity of the foot and ankle, who require stabilization for medical reasons and have the potential to benefit functionally from the orthosis.  

Knee-Ankle-Foot Orthoses (KAFOs)

KAFOs (L2000-L2038, L2126-L2136, and L4370) are considered medically necessary and, therefore, covered for ambulatory individuals who meet the criteria for an AFO and require additional knee stabilization.

Custom-Fabricated AFOs/KAFOs

Custom-fabricated and molded-to-patient-model AFOs/KAFOs (L1900, L1904, L1907, L1920, L1940, L1945, L1950, L1960, L1970, L1980, L1990, L2000, L2005, L2010, L2020, L2030, L2034, L2036, L2037, L2038, L2106, L2108, L2126, L2128, and L4631) are considered medically necessary and, th​erefore, covered for ambulatory individuals when the medical necessity criteria for AFOs/KAFOs listed above are met, and at least one of the following additional criteria is met:
  • The individual cannot be fitted with a prefabricated orthosis.
  • The condition necessitating the orthosis is expected to be permanent or of long-standing duration (more than six months).
  • There is a need to control the knee, ankle, or foot in more than one plane.
  • The individual has a documented neurologic, circulatory, or orthopedic status that requires custom fabricating over a model to prevent tissue injuries.
  • The individual has a healing fracture that lacks normal anatomic integrity or anthropometric proportions.

ANKLE-FOOT ORTHOSES (AFOs) NOT USED DURING AMBULATION 
Static or dynamic positioning ankle-foot orthosis, (including ankle contracture splints/static AFOs) (L4396 or L4397) is considered medically necessary and, therefore, covered for nonambulatory individuals to support a weak or deformed body part or to restrict or eliminate motion in a diseased or injured body part when either of the following criteria is met:
  • The individual has plantar fasciitis; or
  • All of the following criteria are met:
    • The nonfixed ankle plantar flexion contracture exhibits dorsiflexion on passive range-of-motion testing of at least 10 degrees (the pre-treatment passive range of motion is measured with a goniometer).
    • There is reasonable expectation that the device will correct the nonfixed contracture.
    • The nonfixed contracture is interfering or expected to interfere significantly with the individual's functional abilities.
    • The orthosis is a component of a therapy program that includes active stretching of the involved muscles and/or tendons.

Concentric adjustable torsion style mechanisms (L2999) used to assist knee joint extension are considered medically necessary and, therefore, covered for individuals who require knee extension assist in the absence of any co-existing joint contracture.

Concentric adjustable torsion-style mechanisms (L2999) used to assist ankle joint plantarflexion or dorsiflexion are considered medically necessary and, therefore, covered for individuals who require ankle plantar or dorsiflexion assist in the absence of any co-existing joint contracture.

ADDITIONS
Additions to an AFO/KAFO are considered medically necessary and, therefore, covered when the AFO/KAFO is considered medically necessary according to the criteria listed in this policy. Refer to Table I in Attachment A for a list of corresponding codes.

EVALUATION AND FITTING
Evaluation of the individual, measurement and/or casting, and fitting of the orthosis are included in the allowance for the orthosis. There is no separate reimbursement for these services.

REPAIR AND REPLACEMENT
Repair and replacement for AFOs/KAFOs are considered medically necessary and, therefore, covered when the criteria listed in this policy are met for the specific orthosis. In addition the requirements listed in the Repair and Replacement of Durable Medical Equipment (DME) policy must be met.

If the expense for repairs exceeds the estimated expense of providing another entire orthosis, no reimbursement will be made for the excess expense.

The allowance for the labor involved for the replacement for an orthotic component that is coded with a specific Healthcare Common Procedure Coding System (HCPCS) L-code, includes includes fitting and adjustment, is included in the reimbursement for that component.

The allowance for the labor involved in replacing an orthotic component that is coded with the miscellaneous HCPCS code L4210 is separately reimbursable in addition to the allowance for that component.

The reason for the repair or replacement must be documented in the supplier's record.

NOT ELIGIBLE FOR SEPARATE REIMBURSEMENT

Orthotic training may include teaching the individual regarding a wearing schedule, placing and removing the orthosis, skin care and performing tasks while wearing the device. It is not appropriate to include the time spent assessing, measuring or fitting, fabricating or modifying, or making the orthotic in the time spent providing orthotic training. Only the time spent actually training the individual should be included in the orthotic training service.

Evaluation of the individual, measurement and/or casting, and fitting/adjustments of the orthosis are included in the allowance for the orthosis. There is no separate payment for these services.​​

NOT MEDICALLY NECESSARY AFOs/KAFOs

  • A KAFO for a nonambulatory individual is considered not medically necessary and, therefore, not covered.
  • The use of an AFO/KAFO (and any related additions or components) for an ambulatory individual for the treatment of edema and/or the prevention or treatment of a heel pressure ulcer is considered not medically necessary and, therefore, not covered because it does not support a weak or deformed body part or restrict or eliminate motion in a diseased or injured part of the body (i.e., does not meet the definition of an orthosis).
  • If the medical necessity criteria for an AFO/KAFO are not met, the orthosis is considered not medically necessary and, therefore, not covered.
  • If an AFO/KAFO is considered not medically necessary, additions to the orthosis are also considered not medically necessary and, therefore, not covered.
  • A static AFO and replacement interface are considered not medically necessary and, therefore, not covered for an individual who has a fixed ankle plantar flexion contracture.
  • A static AFO and replacement interface are considered not medically necessary and, therefore, not covered for an individual who has foot drop and does not have a nonfixed ankle plantar flexion contracture.
  • Components of a static AFO that are used to position the knee or hip are considered not medically necessary and, therefore, not covered because the effectiveness of these components has not been established.
  • Replacement components (e.g. soft interfaces) in excess of one every six months are considered not medically necessary and, therefore, not covered.
  • Foot drop splints/recumbent positioning devices and related replacement interfaces are considered not medically necessary and, therefore, not covered for ambulatory and nonambulatory individuals with foot drop because, there are other more appropriate treatment modalities.​
NOT COVERED

Femoral and tibial fracture socks (L2840, L2850) used in conjunction with orthoses are not covered by the Company, because they are an item or service not covered by Medicare. Therefore, they are not eligible for reimbursement consideration.

Elastic support garments A4467 are not covered by the Company, because they are an item not covered by Medicare, because they are not rigid or semi-rigid devices. Therefore, they are not eligible for reimbursement consideration.

A foot pressure off-loading/supportive device (A9283) and associated replacement liners (L2999) are not covered by the Company, because they are items not covered by Medicare. Therefore, they are not eligible for reimbursement consideration.

An inverson /eversion correction device (A9285) is not covered by the Company, because it is an item not covered by Medicare. Therefore, it is not eligible for reimbursement consideration.

Additions to a lower-extremity joint, knee, or ankle concentric adjustable torsion-style mechanism (L2861) for custom-fabricated orthotics are not covered by the Company, because they are an item or service not covered by Medicare. Therefore, they are not eligible for reimbursement consideration. 

FACE-TO-FACE REQUIREMENTS 

As a condition for payment, a professional provider must have a face-to-face encounter with the individual for whom the item is ordered that meets all of the following requirements:
· The treating professional provider must have an in-person encounter with the individual within the six (6) months prior to the date of the written order prior to delivery.
· This encounter must document that the individual was evaluated and/or treated for a condition that supports the need for the item(s) of DME ordered.

A new face-to-face encounter is required each time a new standard written order for one of the specified items is ordered. A new standard written order is required:

  • For all claims for purchases or initial rentals 
  • When there is a change in the standard written order for the accessory, supply, drug, etc. 
  • If periodic standard written order renewal required per medical policy
  • When an item is replaced 
  • When there is a change in the supplier 
  • When required by state law 

In this policy the specified items are:
Code
Narrative
L1907
Ankle Orthosis, Supramalleolar With Straps, With Or Without Interface/Pads, Custom Fabricated 
L1932
Afo, Rigid Anterior Tibial Section, Total Carbon Fiber Or Equal Material, Prefabricated, Includes Fitting And Adjustment L1940 Ankle Foot Orthosis, Plastic Or Other Material, Custom-Fabricated 
​L1945
​Ankle Foot Orthosis, Plastic, Rigid Anterior Tibial Section (Floor Reaction), Custom-Fabricated 
​L1950
​Ankle Foot Orthosis, Spiral, (Institute Of Rehabilitative Medicine Type), Plastic, Custom-Fabricated 
​L1951
Ankle Foot Orthosis, Spiral, (Institute Of Rehabilitative Medicine Type), Plastic Or Other Material, Prefabricated, Includes Fitting And Adjustment
L1960
Ankle Foot Orthosis, Posterior Solid Ankle, Plastic, Custom-Fabricated
L1970
Ankle Foot Orthosis, Plastic With Ankle Joint, Custom-Fabricated ​​
L2000
​Knee Ankle Foot Orthosis, Single Upright, Free Knee, Free Ankle, Solid Stirrup, Thigh And Calf Bands/Cuffs (Single Bar Ak Orthosis), Custom-Fabricated 
​L2005
​Knee Ankle Foot Orthosis, Any Material, Single Or Double Upright, Stance Control, Automatic Lock And Swing Phase Release, Any Type Activation, Includes Ankle Joint, Any Type, Custom Fabricated 
​L2010
​Knee Ankle Foot Orthosis, Single Upright, Free Ankle, Solid Stirrup, Thigh And Calf Bands/Cuffs (Single Bar Ak Orthosis), Without Knee Joint, Custom-Fabricated 
​L2020
​Knee Ankle Foot Orthosis, Double Upright, Free Ankle, Solid Stirrup, Thigh And Calf Bands/Cuffs (Double Bar Ak Orthosis), CustomFabricated 
​L2030
​Knee Ankle Foot Orthosis, Double Upright, Free Ankle, Solid Stirrup, Thigh And Calf Bands/Cuffs, (Double Bar Ak Orthosis), Without Knee Joint, Custom Fabricated 
​L2034
​Knee Ankle Foot Orthosis, Full Plastic, Single Upright, With Or Without Free Motion Knee, Medial Lateral Rotation Control, With Or Without Free Motion Ankle, Custom Fabricated 
​L2036
​Knee Ankle Foot Orthosis, Full Plastic, Double Upright, With Or Without Free Motion Knee, With Or Without Free Motion Ankle, Custom Fabricated 
​L2037
​Knee Ankle Foot Orthosis, Full Plastic, Single Upright, With Or Without Free Motion Knee, With Or Without Free Motion Ankle, Custom Fabricated 
​L2038
​Knee Ankle Foot Orthosis, Full Plastic, With Or Without Free Motion Knee, Multi-Axis Ankle,  Custom Fabricated ​
​L2106
​Ankle Foot Orthosis, Fracture Orthosis, Tibial Fracture Cast Orthosis, Thermoplastic Type Casting Material, Custom-Fabricated 
​L2108
​Ankle Foot Orthosis, Fracture Orthosis, Tibial Fracture Cast Orthosis, Custom-Fabricated 
​L2114
​Ankle Foot Orthosis, Fracture Orthosis, Tibial Fracture Orthosis, SemiRigid, Prefabricated, Includes Fitting And Adjustment 
​L2116
​Ankle Foot Orthosis, Fracture Orthosis, Tibial Fracture Orthosis, Rigid, Prefabricated, Includes Fitting And Adjustment 
​L2126
​Knee Ankle Foot Orthosis, Fracture Orthosis, Femoral Fracture Cast Orthosis, Thermoplastic Type Casting Material, Custom-Fabricated 
​L2128
​Knee Ankle Foot Orthosis, Fracture Orthosis, Femoral Fracture Cast Orthosis, Custom-Fabricated 
​L2132
​Kafo, Fracture Orthosis, Femoral Fracture Cast Orthosis, Soft, Prefabricated, Includes Fitting And Adjustment 
​L2134
​Kafo, Fracture Orthosis, Femoral Fracture Cast Orthosis, Semi-Rigid, Prefabricated, Includes Fitting And Adjustment ​
​L2136
​Kafo, Fracture Orthosis, Femoral Fracture Cast Orthosis, Rigid, Prefabricated, Includes Fitting And Adjustment 
​L2350
​Addition  To Lower Extremity, Prosthetic Type, (Bk) Socket, Molded To Patient Model, (Used For Ptb Afo Orthoses) 
​L2510
​Addition To Lower Extremity, Thigh/Weight Bearing, Quadri- Lateral Brim, Molded To Patient Model 
​L2525
​Addition To Lower Extremity, Thigh/Weight Bearing, Ischial Containment/Narrow M-L Brim Molded To Patient Model 
​L2526
​Addition To Lower Extremity, Thigh/Weight Bearing, Ischial Containment/Narrow M-L Brim, Custom Fitted​


REQUIRED DOCUMENTATION

The Company may conduct reviews and audits of services to our members regardless of the participation status of the provider. Medical record documentation must be maintained on file to reflect the medical necessity of the care and services provided. These medical records may include but are not limited to: records from the professional provider’s office, hospital, nursing home, home health agencies, therapies, and test reports.

STANDARD WRITTEN ORDER REQUIREMENTS
Before submitting a claim to the Company, the supplier must have on file a timely, appropriate, and complete standard written order for each item billed that is signed and dated by the professional provider who is treating the member. Requesting a provider to sign a retrospective standard written order at the time of an audit or after an audit for submission as an original standard written order, reorder, or updated order will not satisfy the requirement to maintain a timely professional provider order on file.

PROOF OF DELIVERY REQUIREMENTS
Medical record documentation must include a contemporaneously prepared delivery confirmation or member’s receipt of supplies and equipment. The medical record documentation must include a copy of delivery confirmation if delivered by a commercial carrier and a signed copy of delivery confirmation by member/caregiver if delivered by the DME supplier/provider. All documentation is to be prepared contemporaneous with delivery and be available to the Company upon request.

CONSUMABLE SUPPLIES (WHEN APPLICABLE)
The durable medical equipment (DME) supplier must monitor the quantity of accessories and supplies an individual is actually using. Contacting the individual regarding replenishment of supplies should not be done earlier than approximately seven days prior to the delivery/shipping date. Dated documentation of this contact with the individual is required in the individual’s medical record. Delivery of the supplies should not be done earlier than approximately five days before the individual would exhaust their on-hand supply.

For specified DME items, documentation of a face-to-face encounter between the treating professional provider and the individual meeting the above requirements, including an assessment of the individual’s clinical condition supporting the need for the prescribed DME item(s), must be provided to and kept on file by the DME supplier.

If required documentation is not available on file to support a claim at the time of an audit or record request, the durable medical equipment (DME) supplier may be required to reimburse the Company for overpayments.​




Guidelines


This policy is consistent with Medicare's coverage criteria. The Company's payment methodology may differ from Medicare.

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable Evidence of Coverage, ankle-foot and knee-ankle-foot orthoses are covered under the medical benefits of the Medicare Advantage products when the medical necessity criteria listed in this medical policy are met.

However, services that are identified in this policy as not medically necessary or not covered are not eligible for coverage or reimbursement by the Company.

Description

An orthosis (orthotic), which may also be called a brace or splint, is a rigid or semi-rigid device that supports a weak or deformed body part or restricts or eliminates motion in a diseased or injured part of the body. An orthosis can also be used to treat plantar fasciitis, which is an inflammation of the broad band of fibrous tissue that runs along the bottom surface of the foot. Caused by excessive stretching, plantar fasciitis often leads to heel pain, heel spurs, and/or arch pain if left untreated.

 

An ankle-foot orthosis (AFO) extends well above the ankle (usually near the top of the calf) and is fastened around the lower leg above the ankle. AFOs differ from therapeutic shoes and supportive devices for the foot (e.g., shoe inserts, arch supports), which are placed within the shoe and do not extend above the ankle.

 

A knee-ankle-foot or​thosis (KAFO) supports the knee as well as the ankle and foot.

 

TYPES OF ORTHOSES

 

An orthosis can be classified as prefabricated (off-the-shelf or custom fitted) or custom fabricated.

 

PREFABRICATED (OFF-THE-SHELF) (OTS) ORTHOTICS 

  • Are prefabricated (i.e., manufactured in quantity without a specific individual in mind).
  • May or may not be supplied as a kit that requires some assembly. Assembly of the item and/or installation of add-on components and/or the use of some basic materials in preparation of the item does not change classification from OTS to custom fitted.
  • Require minimal self-adjustment (i.e., an adjustment the individual, caretaker for the beneficiary, or supplier of the device can perform) for fitting at the time of delivery for appropriate use and do not require expertise in trimming, bending, molding, assembling, or customizing to fit an individual.
  • Do not require the expertise of a certified orthotist or an individual who has equivalent specialized training in the provision of orthoses to fit the item to the individual.
​Fabrication of an orthosis using computer-aided design/computer-aided manufacturing (CAD/CAM) or similar technology without the creation of a positive model with minimal self-adjustment at delivery is considered OTS.

CUSTOM-FITTED ORTHOTICS
  • Are devices that are prefabricated.
  • They may or may not be supplied as a kit that requires some assembly. Assembly of the item and/or installation of add-on components and/or the use of some basic materials in preparation of the item does not change classification from OTS to custom fitted.
  • Require substantial modification (i.e., changes made to achieve an individualized fit) for fitting at the time of delivery in order to provide an individualized fit, i.e., the item must be trimmed, bent, molded (with or without heat), or otherwise modified resulting in alterations beyond minimal self-adjustment.
  • Require the expertise of a certified orthotist or an individual who has equivalent specialized training in the provision of the orthosis to fit the item to the individual beneficiary.
Use of CAD/CAM or similar technology to create an orthosis without a positive model of the patient may be considered custom fitted if the final fitting upon delivery to the individual requires substantial modification requiring expertise.

CUSTOM-FABRICATED ORTHOTICS
  • Are devices that are made for a specific individual.
  • Are made with basic materials including, but not limited to: plastic, metal, leather, or cloth in the form of sheets, bars, etc.
  • Involve substantial work such as cutting, bending, molding, and sewing.
  • Require more work than merely modifying a prefabricated item, although some prefabricated components may be used in the construction of the device.
​A molded-to-patient-model orthosis is a type of custom-fabricated orthosis in which an impression of a specific body part is made (by means of a plaster cast, CAD-CAM technology, or other techniques) and used to make a positive model of the body part. The orthosis is then molded on this model.

The Charcot's restraint orthotic walker (CROW) orthosis is a custom fabricated ankle-foot orthosis used by an ambulatory individual and has all of the following characteristics:

  • Is designed to maintain the foot at a fixed position of 0 degrees (i.e., perpendicular to the lower leg).
  • Allows for varus or vulgus deformity correction.
  • Contains a rocker bottom sole with a custom arch support.
  • Incorporates a rigid anterior tibial shell.
  • Has a soft interface
  • Totally encapsulated  
ORTHOSES FOR AMBULATORY AND NONAMBULATORY INDIVIDUALS

DYNAMIC ORTHOSIS
A dynamic orthosis is appropriate for an ambulatory individual because it gives support to a moving body part (e.g., ankle) to optimize its function. Ambulatory individuals include those who are able to walk a distance, as well as those who are able only to stand and/or transfer. AFOs and KAFOs may be used by ambulatory individuals.

STATIC ORTHOSIS
A static orthosis is a rigid brace that supports a body part in a fixed position; it may be used for individuals who are minimally ambulatory or nonambulatory. Nonambulatory individuals may use either an ankle contracture splint, night splint or a foot drop splint.

Ankle Contracture Splint

Ankle contracture splints are prefabricated static AFOs that are commonly used to treat ankle plantar flexion contractures. An ankle plantar flexion contracture occurs when the muscles and/or tendons that plantarflex the ankle are shortened, which results in an inability to bring the ankle to 0 degrees by passive range of motion. Zero degrees ankle position is when the foot is perpendicular to the lower leg. Ankle contracture splints are used by individuals who are minimally ambulatory or nonambulatory.

An ankle contracture splint has all of the following characteristics:

  • Accommodates either plantar fasciitis or an ankle plantar flexion contracture up to 45 degrees
  • Applies a dorsiflexion force to the ankle
  • Allows pressure reduction
  • Has a soft interface
Ankle-Foot Orthoses (AFOs)/Knee-Ankle-Foot Orthoses (KAFOs) Used for Night Splinting

Ankle-foot orthoses (AFOs) and knee-ankle-foot orthoses (KAFOs) are used in the treatment of muscle contractures in children with neuromuscular disorders (e.g., cerebral palsy (CP).  The term "orthotic management in rest" may also be used instead of "night splinting" to describe the use of splints during rest.

A night splint has the following characteristics:

  • Used during sleep or rest periods
  • Used to minimize the impact or limit the degree of a contracture
  • Used to improve range of motion and reduce spasticity of the surrounding muscles
Foot Drop Splint/Recumbent Positioning Device

Foot drop is a condition in which there is weakness and/or lack of use of the muscles that dorsiflex the ankle, but the ankle can be brought to 0 degrees by passive range of motion. Foot drop splints/recumbent positioning devices are used by individuals who are nonambulatory. A foot drop splint/recumbent positioning device is a prefabricated AFO that has all of the following characteristics:

  • Maintains the foot at a fixed position of 0 degrees (i.e., perpendicular to the lower leg)
  • Is not designed to accommodate an ankle plantar flexion contracture
  • Has a soft interface
Inversion/Eversion Correction Device

The Agilium Freestep, an ankle foot orthosis, indicated for medial or lateral unicompartmental osteoarthritis. The device is proposed to control the subtalar joint in combination with a lever arm to counter the varus moment acting on the knee.



References

Centers for Medicare & Medicaid Services (CMS). Department of Health and Human Services. Final Rule: Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule Amounts, DMEPOS Competitive Bidding Program (CBP) Amendments, Standard Elements for a DMEPOS Order, and Master List of DMEPOS Items Potentially Subject to a Face-to-Face Encounter and Written Order Prior to Delivery and/or Prior Authorization Requirements. Rules and Regulations. 11/09/2019. Available at:https://www.cms.gov/files/document/esrd-qip-final-rule-2019-24063.pdf-0. Accessed April 5, 2021.

Centers for Medicare & Medicaid Services (CMS). MLN Matters. Standard Elements for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Order, and Master List of DMEPOS Items Potentially Subject to a Face-toFace Encounter and Written Orders Prior to Delivery and, or Prior Authorization Requirements. [CMS Web site.] Effective 01/01/2020.  Available at: https://www.cms.gov/files/document/se20007.pdf​. Accessed April 5, 2021. 


Evidence of Coverage.

Noridian. Local Coverage Determination (LCD): Ankle-foot/knee-ankle-foot Orthosis (L33686). Original effective date 10/01/2015. Effective 01/01/2020. Available at:
https://med.noridianmedicare.com/documents/2230703/7218263/Ankle-Foot+Knee-Ankle-Foot+Orthosis+LCD/7af687cc-36e4-4b06-bf1c-f657797576ef. Accessed April 5, 2021. 

Noridian. Local Coverage Article for Ankle-foot/knee-ankle-foot Orthoses - Policy Article – Effective January 2017(A52457). Effective 01/01/2020. Available at:
https://med.noridianmedicare.com/documents/2230703/7218263/Ankle-Foot+Knee-Ankle-Foot+Orthosis+LCD/7af687cc-36e4-4b06-bf1c-f657797576ef. Accessed April 5, 2021. 

Noridian. Noncovered items. [Noridian Web site]. Revised: December 19, 2019. Available at: https://med.noridianmedicare.com/web/jadme/topics/noncovered-items. Accessed April 5, 2021. 


Coding

CPT Procedure Code Number(s)
N/A

ICD - 10 Procedure Code Number(s)
N/A

ICD - 10 Diagnosis Code Number(s)

L4392, L4396 and L4397 DEVICES ARE MEDICALLY NECESSARY WHEN REPORTED WITH THE FOLLOWING DIAGNOSIS CODES:

M24.571 Contracture, right ankle

M24.572 Contracture, left ankle

M24.573 Contracture, unspecified ankle

M24.574 Contracture, right foot

M24.575 Contracture, left foot

M24.576 Contracture, unspecified foot

M72.2 Plantar fascial fibromatosis

L4631 DEVICE IS MEDICALLY NECESSARY WHEN REPORTED WITH THE FOLLOWING DIAGNOSIS CODES:

A52.16 Charcot's arthropathy (tabetic)

E08.610            Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy

E09.610            Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy

E10.610            Type 1 diabetes mellitus with diabetic neuropathic arthropathy

E11.610            Type 2 diabetes mellitus with diabetic neuropathic arthropathy

M14.671 Charcot's joint, right ankle and foot

M14.672 Charcot's joint, left ankle and foot

M14.679 Charcot's joint, unspecified ankle and foot


HCPCS Level II Code Number(s)
See Attachment A

Revenue Code Number(s)
N/A



Coding and Billing Requirements


Policy History

8/2/2021
8/2/2021
MA05.010
Medical Policy Bulletin
Medicare Advantage
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No