Skip navigation

Linda Collins Blogger

New K codes…what you need to know to be oK.

Posted by Linda Collins | September 30, 2014

Effective October 1, 2014 Medicare has created two new codes describing off-the- shelf knee orthoses: K0901 (single upright) and K0902 (double upright). For now, the Medicare fee schedule for K0901 and K0902 is the same as their custom-fit counterparts, L1843, and L1845, respectively. We expect Medicare to adjust the off-the-shelf fees for these codes if and when it includes OTS orthotics in competitive bidding. Also, CMS may elect to convert these K codes to L codes in future releases of the Medicare fee schedule. Stay tuned to R&R for more information as it is released. 

What does this mean for you?

If you deliver a knee orthosis and it only requires minimal self-adjustment by the patient, then you should use code K0901 for a single upright device and K0902 for  a double upright. On the other hand, when an individual with the required expertise trims, bends, molds, assembles, or otherwise customizes the brace to fit a specific patient, then codes L1843 (single upright) or L1845 (double upright) would apply. (For more information about this topic see Code Confusion & OTS Orthotics: What Can You Do? )

Documenting exactly what is done to the brace at time of fitting and who does it is critical. We are seeing Medicare audits where entire claims are being denied due to lack of documentation. So, remember to document, document, document.

Remember, the codes are not effective until October 1, 2014, so do not use them until that date.

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]