Skip navigation

Linda Collins Blogger

Are Night Splints Covered by Medicare?

Posted by Linda Collins | December 12, 2017

According to the Local Coverage Determination L33686, braces not used during ambulation may be covered if the following four criteria are documented:

  1. Plantar flexion contracture of the ankle
  2. Expectation of ability to correct the contracture
  3. Contracture is interfering with patient's ADLs
  4. The brace is used along with a program of active stretching.

Additionally, a night splint may be covered if the patient has a diagnosis of plantar fasciitis (M72.2.)

Here is the tricky part….only braces with HCPCS L4396 or L4397 are covered. When a brace is billed with HCPCS L4398 it will be denied as not covered, even if the above mentioned medical criteria is documented. The LCD specifically states "Medicare does not reimburse for a foot drop/recumbent positioning device (L4398)…"

What does this mean for you?

Understand the medical coverage criteria for AFOs and document the details in the patient's medical record.

Check the products you are currently using. If an AFO is assigned HCPCS L4398, be aware this will not be covered by Medicare. Talk to your Össur representative about alternative braces available.

Review the AFO Reimbursement Fact Sheet and Night Splint Reimbursement Fact Sheet found in the Reimbursement Resources section.

Össur R&R

The Source for O&P Reimbursement & Regulatory News & Analysis

If you have any questions for Össur’s Reimbursement Team or about Össur’s Reimbursement Services, please contact us at [email protected]