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Linda Collins Blogger

Same or Similar Orthotics

Posted by Linda Collins | January 30, 2018

A supplier may receive a denial when the claims history indicates a "same or similar" device previously billed for the same patient within the reasonable useful lifetime of the brace. Noridian, Region A and D DME MAC has released a Same or Similar Reference Chart, which includes AFO, KAFO, KO and SO orthoses. It is likely this information will be incorporated into the other DME MACs shortly.

What does this mean for you?

When delivering an ankle, knees, or back brace to a patient, check to see if they have received a same or similar device in the past. You can check on the DME MAC sites listed below:

Use this chart to determine if the device you are giving is "same or similar".

Item Same HCPCS Category
AFO/KAFO - Knee/Ankle/Foot OrthosisL2000, L2005, L2010, L2020, L2030, L2034, L2035, L2036, L2037, L2038, L2126, L2128, L2132, L2134, L2136
AFO/KAFO - Ankle OrthosisL1902, L1904, L1907, L4350
AFO/KAFO - Ankle/Foot Orthosis
L1900, L1906, L1910, L1920, L1930, L1932, L1940, L1945, L1950, L1951, L1960, L1970, L1971, L1980, L1990, L2106, L2108, L2112, L2114, L2116
AFO/KAFO - Ankle/Foot Orthosis-Non ambulatoryL4396, L4397, L4398
AFO/KAFO - Walking BootL4360, L4361, L4370, L4386
Knee OrthosesL1810, L1812, L1820, L1830, L1831, L1832, L1833, L1834, L1836, L1840, L1843, L1844, L1845, L1846, L1847, L1848, L1850, L1851, L1852, L1860
Spinal Orthoses - Lumbar OrthosesL0625, L0626, L0627, L0641, L0642
Spinal Orthoses - Lumbar Sacral OrthosesL0628, L0629, L0630, L0631, L0632, L0633, L0634, L0635, L0636, L0637, L0638, L0639, L0640, L0643, L0648, L0649, L0650, L0651
Spinal Orthoses - Sacral OrthosesL0621, L0623
Spinal Orthoses - Thoracic Lumbar Sacral OrthosisL0450, L0452, L0454, L0455, L0456, L0457, L0458, L0460, L0462, L0464, L0466, L0467, L0468, L0469, L0470, L0472, L0480, L0482, L0484, L0486, L0488, L0490, L0491, L0492


You may use an Advanced Beneficiary Notice (ABN) if the patient has received the same device, according to the above chart, in the past.

For more information, read the full announcement here.

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