New OTS Orthotic Codes
CMS approved two new HCPCS codes for prefabricated, off-the-shelf ankle foot orthoses to parallel current HCPCS codes L1932 and L1951. This article will summarize these new codes, including their reimbursement rates and effective date.
What You Need to Know
During the second biannual 2024 HCPCS coding cycle, Ottobock submitted a request to the HCPCS coding committee to create parallel OTS codes to describe their WalkOn and WalkOn Reaction AFOs, which are PDAC verified for custom-fit codes L1951 and L1932, respectively. The committee approved the request and created codes L1952 and L1933 to describe an OTS version of each orthosis. CMS added these codes to the Q2 HCPCS file, and they can be used for billing orthoses delivered on or after April 1, 2025. CMS also determined the fee schedule amount for each new code, which is equivalent to the fee schedule for the respective custom-fit codes. Therefore, the reimbursement rates for L1933 and L1952 are equivalent to the reimbursement rates for L1932 and L1951, respectively. Lastly, the coding committee decided to modify the description of L1932 and L1951 to match other custom-fit codes with OTS parallel codes. The complete descriptions of all four codes are:
- L1933: Ankle foot orthosis, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, off-the-shelf
- L1932: Ankle foot orthosis, rigid anterior tibial section, total carbon fiber or equal material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
- L1952: Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, off-the-shelf
- L1951: Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
What this Means for You
Previously, if you provided an L1932 or L1951 brace with "minimal self-adjustments," Medicare required billing with miscellaneous code L2999 because these were custom-fit codes without an OTS equivalent. However, starting this month, OTS parallel HCPCS codes L1933 and L1952 are valid and billable for any deliveries on or after April 1, 2025. This will eliminate the need to bill a miscellaneous code when delivering these braces without significant modifications. Along with providing education to your staff about these changes, make sure to update your EMR system to include the new HCPCS codes and their associated fee schedules.
For more information, review pages 43-50 of the HCPCS Application Summary for the 2024 second biannual coding cycle.