Are you aware that the Centers for Medicare and Medicaid Services (CMS) has eliminated the 90-day grace period for transitioning to the new 2005 HCPCS codes? Effective on Jan. 1, CMS will only pay claims that bill for 2005 codes.
That means it’s vital to be current on all of the code additions—including one for stance control knee orthoses—code deletions and changes to code descriptors. AOPA created a comprehensive summary of the 2005 codes and alerted members to them in mid-November.
L1932 - AFO rigid anterior tibial section, total carbon fiber or equal material, prefabricated, includes fitting and adjustment.
L2005 - Knee-ankle-foot orthosis, any material, single or double upright, stance control, automatic lock and swing-phase release, mechanical activation, includes ankle joint, any type, custom fabricated.
L2232 - Addition to lower-extremity orthosis, rocker bottom for total contact ankle-foot orthosis, for custom-fabricated orthosis only.
L4002 - Replacement strap, any orthosis, includes all components, any length, any type.
L5685 - Addition to lower-extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each.
L5856 - Addition to lower-extremity prosthesis, endoskeletal knee-shin system, microprocessor-control feature, swing and stance phase, includes electronic sensor(s), any type.
L5857 - Addition to lower-extremity prosthesis, endoskeletal knee-shin system, microprocessor-control feature, swing phase only, includes electronic sensor(s), any type.
L6694 - Addition to upper-extremity prosthesis, below elbow/ above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism.
L6695 - Addition to upper-extremity prosthesis, below elbow/ above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism.
L6696 - Addition to upper-extremity prosthesis, below elbow/ above elbow, custom-fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only. (For other than initial, use code L6694 or L6695.)
L6697 - Addition to upper-extremity prosthesis, below elbow/ above elbow, custom-fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only. (For other than initial, use code L6694 or L6695.)
L6698 - Addition to upper-extremity prosthesis, below elbow/ above elbow, lock mechanism, excludes socket insert.
L7181 - Electronic elbow, microprocessor simultaneous control of elbow and terminal device.
In addition to 13 new codes for 2005, CMS also reinstated one code: L0430. However, AOPA has confirmed with the SADMERC that this code was reinstated only for the DeWall Posture Protector.
L0430 - Spinal orthosis, anterior- posterior-lateral control, with interface material, custom fitted (DeWall Posture Protector only).
CMS deleted nine L codes. According to the SADMERC, some of the deleted codes have been crosswalked to other codes. As of Dec. 31, 2004, you can no longer bill for these deleted codes:
L0476 - TLSO, sagittal-coronal control, flexion compression jacket, two rigid plastic shells with soft liner, posterior extends from sacrococcygeal junction and terminates at or before the T-9 vertebra, anterior extends from symphysis pubis to xiphoid, usually laced together on one side, restricts gross trunk motion in sagittal and coronal planes, allows free flexion and compression of the LS region, includes straps and closures, prefabricated, includes fitting and adjustment. According to the SADMERC, this code was crosswalked to K0644.
L0478 - TLSO, sagittal-coronal control, flexion compression jacket, two rigid plastic shells with soft liner, posterior extends from sacrococcygeal junction and terminates at or before the T-9 vertebra, anterior extends from symphysis pubis to xiphoid, usually laced together on one side, restricts gross trunk motion in sagittal and coronal planes, allows free flexion and compression of LS region, includes straps and closures, custom fabricated. According to the SADMERC, this code was crosswalked to K0645.
L2435 - Addition to knee joint, polycentric joint, each joint.
L5674 - Addition to lower extremity, below knee, suspension sleeve, any material, each.
L5675 - Addition to lower extremity, below knee, suspension sleeve, heavy duty, any.
L5846 - Addition, endoskeletal, knee-shin system, microprocessor-control feature, swing phase only.
L5847 - Addition, endoskeletal knee-shin system, microprocessor-control feature, stance phase only.
L5989 - Addition to lower-extremity prosthesis, endoskeletal system, pylon with integrated electronic force sensors.
L8490 - Addition to prosthetic sheath/sock, air seal suction retention system.
CMS changed 17 L code descriptors. The new descriptors went into effect on the first of this month. See the box below for code descriptor changes.
| HCPCS |
NEW DESCRIPTOR |
OLD DESCRIPTOR |
| L1820 | Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, included fitting and adjustment. | KO, elastic with condylar pads and joints, prefabricated, includes fitting and adjustment. |
| L2035 | Knee-ankle-foot orthosis, full plastic, static (pediatric size), without free motion ankle, prefabricated, includes fitting and adjustment. | KAFO, full plastic, static (pediatric size), prefabricated, includes fitting and adjustment. |
| L2036 | Knee-ankle-foot orthotsis, full plastic, double upright, free knee, with or without free motion ankle, custom fabricated. | KAFO, full plastic, double upright, free knee, custom fabricated. |
| L2037 | Knee-nakle-foot orthosis, full plastic, single upright, free knee, with or without free motion ankle, custom fabricated. | KAFO, full plastic, single upright, free knee, custom fabricated. |
| L2038 | Knee-ankle-foot orthosis, full plastic, without knee joint, multi-axis ankle, custom fabricated. | KAFO, full plastic, with knee joint, multi-axis, (Lively orthosis or equal), custom fabricated. |
| L2039 | Knee-ankle-foot orthosis, full plastic, single upright, poly-azial hinge, medial lateral rotation control, with or without free motion ankle, custom fabricated. | KAFO, full plastic, single upright, poly-axial hing, medial lateral rotation control, custom fabricated. |
| L2320 | Addition to lower extremity, nonmolded lacer, for custom-fabricated orthosis only. | Addition to lower extremity, nonmolded lacer. |
| L2330 | Addition to lower extremity, lacer molded to patient model, for custom-fabricated orthosis only. | Addition to lower extremity, lacer molded to patient model. |
| L2755 | Addition to lower-extremity orthotsis, high strength, ligthweight material, all hybrid lamination/prepreg composite, per segment, for custom-fabricated orthosis only. | KAFO, full plastic, double upright, free knee, custom fabricated. |
| L2800 | Addition to lower-extremity orthosis, knee control, knee cap, medial or lateral pull, for use with custom-fabricated orthosis only. | Addition to lower-extremity orthosis, knee control, knee cap, medial or lateral pull. |
| L4040 | Replace molded thigh lacer, for custom-fabricated orthosis only. | Replace molded thigh lacer. |
| L4045 | Replace nonmolded thigh lacer, for custom-fabricated orthosis only. | Replace nonmolded thigh lacer. |
| L4050 | Replace molded calf lacer, for custom-fabricated orthosis only. | Replace molded calf lacer. |
| L4055 | Replace nonmolded calf lacer, for custom-fabricated orthosis only. | Replace nonmolded calf lacer. |
| L6890 | Addition to upper-extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment. | Terminal device, glove for above hands, production glove. |
| L6895 | Addition to upper-extremity prosthesis, glove for terminal device, any material, custom fabricated. | Terminal device, glove for above hands, custom glove. |
| L7180 | Electronic elbow, microprocessor sequential control of elbox and terminal device. | Electronic elbow, Boston, Utah or equal, myoelectronically controlled. |