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Linda Collins Blogger

OA Knee Bracing: Coding

Posted by Linda Collins | June 28, 2016

Knee osteoarthritis (OA) diagnoses are on the increase. As the population ages and remains active longer, all parts of the health system are looking for alternatives to surgical treatment of OA. In fact, many payers are requiring conservative treatment before authorizing total joint replacement surgery. Knee bracing is typically considered a possible conservative treatment modality (See Knee Bracing Before Total Joint Replacement Surgery). Providing OA braces to patients is an easy and viable option that provides immediate results.

Are you familiar with the coding, coverage and reimbursement issues associated with the Unloader OA knee brace? In this three-part series, we will discuss the basics involved in documenting and submitting Unloader OA knee brace claims to Medicare and private insurers.

Base Codes

There are several codes and product options for OA knee bracing:

Össur OA Knee Braces
Off the Shelf Code Knee Brace Name Custom-Fit Code
K0901 Form Fit OA WraparoundL1843
K0901 Unloader OneL1843
K0901 Unloader FitL1843
K0901 Unloader SpiritL1843
K0901 Unloader One PlusL1843
K0902 Rebound DUALL1845


Additional codes for truly custom-made braces:

Unloader One Custom - L1844

Unloader Custom - L1844

CTi OA Custom - L1846

Rebound DUAL Custom - L1846


Off the Shelf (OTS) codes are used to bill the brace when there is "minimal self-adjustment" at the time of fitting. Custom-fit codes are used when there are substantial modifications made to achieve an individualized fit of the item. The substantial modifications must be documented and performed by a certified orthotist or an individual who has equivalent specialized training. (More information about documenting custom-fit codes can be found here).


Add-on Codes

A suspension sleeve (L2397) is billable with the base knee brace if there is documented medical necessity such as:

  • Skin sensitivity (history, predisposition, concern)
  • Moisture management
  • Dirt/foreign body barrier (usually ADL related)
  • Soft Tissue Containment
  • Edema/Swelling control

Heavy-duty knee joints (L2385, L2395) are billable if the patient weighs more than 300 pounds.



Orthotic claims require a modifier to indicate which side of the body the brace will be supporting: "LT" for left side and "RT" for right side. For bilateral braces billed on the same date of service, use a double modifier of "LTRT" with the HCPCS code.


Add a "KX" modifier to knee orthoses base and addition codes if documentation of medical necessity is in the patient's medical record.


Coding Verification

The only products billable using code L1845 are those for which the Pricing, Data Analysis, and Coding (PDAC) contractor has made a written coding verification. Check the website,, to check the product listing prior to claims submission.

Next up in the series will be a post on coverage and medical necessity of OA knee bracing. 

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