Knee Orthoses

Medicare covers specific prefabricated and custom knee orthoses when reasonable and necessary criteria are met: prefabricated devices for ambulatory patients with weakness/deformity or instability, locking/rigid orthoses for nonfixed contractures with ≥10° passive ROM, immobilizers and adjustable-joint orthoses for recent injury/surgery or documented instability, and custom devices only when a documented physical characteristic requires them. Several codes and additions are explicitly denied (e.g., L1847/L1848 inflatable bladder, additions when the base is not reasonable), heavy-duty joints are limited to beneficiaries >300 lbs, and specific documentation (SWO/WOPD, proof of delivery, physical exam/joint laxity tests, justification for custom fabrication) is required for coverage.

"Prefabricated knee orthoses L1810, L1812, L1820, or L1821 are covered for ambulatory beneficiaries with knee weakness or deformity who require stabilization."