Add On Codes for Knee Orthosis

What addition codes can be billed with knee orthoses? The Local Coverage Determination: Knee Orthosis (L33318) provides clear guidance.

Addition codes are identified as one of the following categories:

• Eligible for separate payment
• Not reasonable and necessary
• Not separately payable
• Incompatible

Eligible for separate payment codes are those that are frequently incorporated into the base knee orthosis. They may be eligible for payment if the base knee orthosis is medically necessary and the addition is medically necessary.

If the base knee orthosis is not considered medically necessary, any addition codes will also be denied as not medically necessary.

Certain codes describe components that may already be a part of the base code. These items are not separately payable.

Incompatible codes are those that are not considered to be a function of a knee orthosis or do not meet definition of braces.

The LCD provides a clear chart indicating which addition codes can be used with specific base knee orthosis codes. You may access the LCD here.