Knee Orthoses - Policy Article
A52465
Medicare covers knee orthoses that are rigid or semi-rigid and medically necessary to support a weak/deformed knee or to restrict/eliminate motion for disease or injury, provided they meet the related LCD reasonable-and-necessary and statutory requirements and are coded correctly per minimal self-adjustment rules. Specific documentation is required for certain HCPCS (e.g., L1832/L1833/L1850; L1843–L1846/L1851–L1852), including joint laxity testing, ambulatory status, and imaging for tibiofemoral osteoarthritis; non-rigid supports (A4467) are noncovered, coding errors and failure to obtain face-to-face encounter/WOPD for Final Rule 1713 items will result in denial, and payments may be bundled into hospital/SNF facility payments with limited DME MAC eligibility within two days prior to discharge.
"A knee orthosis is covered when it is a rigid or semi-rigid device used to support a weak or deformed knee or to restrict or eliminate motion in a diseased or injured knee and the device meets the ..."