- O-AFOs
- O-Ankle Stirrups/Gauntlets/SMOs
- O-COs/CTOs/HALOs
- O-Cranial Orthoses
- O-Electrical Stimulation (FES)
- O-EOs/EWHOs/EWHFOs
- O-FOs, Foot plates, and Shoes
- O-Hip Orthoses/HKAFOs
- O-HOs/HFOs/FOs
- O-Humeral Fx Orthoses
- O-KAFO
- O-Knee Orthoses
- O-LSOs/LOs/SI Belts/Truss
- O-SOs/SEWHOs/SEWHFOs
- O-Symes/Partial Foot
- O-TLSOs/Scoliosis/Pectus/Rib Belts
- O-Ulnar Radius Fx Ox
- O-WHOs/WHFOs
- P-Hip Disarticulation/Pelvectomy
- P-Knee Disarticulation
- P-Transfemoral
- P-Transtibial
A5500-For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe
This code is commonly billed along side of Diabetic Inserts A-Codes
This code is commonly billed along side of Diabetic Inserts A-Codes
Shoes Modification Codes
A5503- For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per shoe
A5504- For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe
A5505- For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe
A5506- For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe
A5507- For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe
A5508- For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe
A5501-For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoe
This code is commonly billed along side of Diabetic Inserts A-Codes
The following add-on codes may be used for this base code (only code for what you use):
Shoes Modification Codes
A5503- For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per shoe
A5504- For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe
A5505- For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe
A5506- For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe
A5507- For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe
A5508- For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe
A5510-For diabetics only, direct formed, compression molded to patient's foot without external heat source, multiple-density insert(s) prefabricated, per shoe
We do not suggest billing add-on codes with the base code above. However, this code is commonly billed along side of Diabetic Shoe A-Codes
A5500-For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe
A5501-For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoe
A5512-For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each
We do not suggest billing add-on codes with the base code above. However, this code is commonly billed along side of Diabetic Shoe A-Codes
A5500-For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe
A5501-For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoe
A5513-For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer or higher), includes arch filler and other shaping material, custom fabricated, each
We do not suggest billing add-on codes with the base code above. However, this code is commonly billed along side of Diabetic Shoe A-Codes
A5500-For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe
A5501-For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoe
A8000-Helmet, protective, soft, prefabricated, includes all components and accessories
We do not suggest billing add-on codes with the base code above.
A8001-Helmet, protective, hard, prefabricated, includes all components and accessories
We do not suggest billing add-on codes with the base code above.
A8002-Helmet, protective, soft, custom fabricated, includes all components and accessories
We do not suggest billing add-on codes with the base code above.
A8003-Helmet, protective, hard, custom fabricated, includes all components and accessories
We do not suggest billing add-on codes with the base code above.
A8004-Soft interface for helmet, replacement only
We do not suggest billing add-on codes with the base code above.
E0770-Functional electrical stimulator, transcutaneous stimulation of nerve and/or muscle groups, any type, complete system, not otherwise specified
Commonly associated with the WalkAide System which includes: Control Unit, lead cables, Bi-Flex cuff, 4 electrodes (1 pack = 1 month supply)
The following add-on codes may be used for this base code (only code for what you use):
A4595-Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes)
WalkAide Electrodes: Single Pack
1 pack per Month = 4 Leads = 2 sets Input as quantity of 2 units
E1399-Durable medical equipment, miscellaneous
L0112-Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated
We do not suggest billing add-on codes with the base code above.
L0113-Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment
We do not suggest billing add-on codes with the base code above.
L0120-Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar)
We do not suggest billing add-on codes with the base code above.
L0452-Tlso, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, custom fabricated
The following add-on codes may be used for this base code (only code for what you use):
Custom TLSO Additions
L0974- Tlso full corset
L0978- Axillary crutch extension
L1240- Lumbar derotation pad
L1250- Addition to tlso, (low profile), anterior asis pad
L1260- Addition to tlso, (low profile), anterior thoracic derotation pad
L1290- Addition to tlso, (low profile), lateral trochanteric pad
Custom or Prefab TLSO Additions
L0980- Peroneal straps, prefabricated, off-the-shelf, pair
L0982- Stocking supporter grips, prefabricated, off-the-shelf, set of four (4)
L0984- Protective body sock, prefabricated, off-the-shelf, each
One or more of the following criteria should be met for the spinal orthosis to be covered by Medicare.
1. To reduce pain by restricting mobility of the trunk
2. To facilitate healing following an injury to the spine or related soft tissues
3. To facilitate healing following a surgical procedure on the spine or related soft tissue
4. To otherwise support weak SPINAL muscles and/or a deformed spine
L0454-Tlso flexible, provides trunk support, extends from sacrococcygeal junction to above t-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0455-Tlso, flexible, provides trunk support, extends from sacrococcygeal junction to above t-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf
The following add-on codes may be used for this base code (only code for what you use):
Custom or OTS TLSO Additions
L0980- Peroneal straps, prefabricated, off-the-shelf, pair
L0982- Stocking supporter grips, prefabricated, off-the-shelf, set of four (4)
L0984- Protective body sock, prefabricated, off-the-shelf, each
L0456-Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
The following add-on codes may be used for this base code (only code for what you use):
Any TLSO Additions
L0980- Peroneal straps, prefabricated, off-the-shelf, pair
L0982- Stocking supporter grips, prefabricated, off-the-shelf, set of four (4)
L0984- Protective body sock, prefabricated, off-the-shelf, each
L0457-Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated, off-the-shelf
The following add-on codes may be used for this base code (only code for what you use):
Custom or OTS TLSO Additions
L0980- Peroneal straps, prefabricated, off-the-shelf, pair
L0982- Stocking supporter grips, prefabricated, off-the-shelf, set of four (4)
L0984- Protective body sock, prefabricated, off-the-shelf, each
L0458-Tlso, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment
The following add-on codes may be used for this base code (only code for what you use):
Custom or Prefab TLSO Additions
L0980- Peroneal straps, prefabricated, off-the-shelf, pair
L0982- Stocking supporter grips, prefabricated, off-the-shelf, set of four (4)
L0984- Protective body sock, prefabricated, off-the-shelf, each
L0460-Tlso, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
The following add-on codes may be used for this base code (only code for what you use):
Custom or Prefab TLSO Additions
L0980- Peroneal straps, prefabricated, off-the-shelf, pair
L0982- Stocking supporter grips, prefabricated, off-the-shelf, set of four (4)
L0984- Protective body sock, prefabricated, off-the-shelf, each
L0460-Tlso, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
The following add-on codes may be used for this base code (only code for what you use):
Custom or Prefab TLSO Additions
L0980- Peroneal straps, prefabricated, off-the-shelf, pair
L0982- Stocking supporter grips, prefabricated, off-the-shelf, set of four (4)
L0984- Protective body sock, prefabricated, off-the-shelf, each
L0462-Tlso, triplanar control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment
The following add-on codes may be used for this base code (only code for what you use):
Any TLSO Additions
L0980- Peroneal straps, prefabricated, off-the-shelf, pair
L0982- Stocking supporter grips, prefabricated, off-the-shelf, set of four (4)
L0984- Protective body sock, prefabricated, off-the-shelf, each
L0462-Tlso, triplanar control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment
The following add-on codes may be used for this base code (only code for what you use):
Custom or Prefab TLSO Additions
L0980- Peroneal straps, prefabricated, off-the-shelf, pair
L0982- Stocking supporter grips, prefabricated, off-the-shelf, set of four (4)
L0984- Protective body sock, prefabricated, off-the-shelf, each
L0464-Tlso, triplanar control, modular segmented spinal system, four rigid plastic shells, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment
The following add-on codes may be used for this base code (only code for what you use):
Custom or Prefab TLSO Additions
L0980- Peroneal straps, prefabricated, off-the-shelf, pair
L0982- Stocking supporter grips, prefabricated, off-the-shelf, set of four (4)
L0984- Protective body sock, prefabricated, off-the-shelf, each