What is the Knee Brace CPT Code? - A Summary of Knee Brace Billing for Medical Providers
For knee braces (and bracing in general), the codes that you will encounter are actually HCPCS Level II codes - HCPCS Level II includes codes for a number of healthcare services that cannot be easily classified within the CPT system. These codes consist of a 5 character alphanumeric code, with the first character being a letter that describes the category of service or product. All medical bracing falls under the “L” category for orthotic and prosthetic procedures and devices, with the four numbers following the L defining the body part and what type of orthosis/prosthesis.
There are a range of codes for different knee braces.
When it comes to knee braces, there is a wide range of different codes you might encounter. Some of the more common codes for knee braces are the following:
- L1843 Custom Fit L1851 OTS Single sided unloading knee brace that would typically be used for an unicompartmental osteoarthritis patient.
- L1832 Custom Fit L1833 OTS Knee braces that have a range of motion dial to control flexion and extension. These can be neoprene or more rigid for post operative patients.
- L1845 Custom Fit L1852 OTS Ligament support brace with dual uprights to protect and prevent further injury of the knee.
- L1820 Custom Fit Neoprene knee brace with light duty hinges without range of motion control.
Centers for Medicare & Medicare Services (CMS) has split many of the knee braces codes. The codes represent how the patient was fit with the brace, not the actual brace. Your custom fit codes are billed when you modify the brace to be specific to the patient. An example would be using bending irons to change the shape of a strut to accommodate the angle of the thigh proportionate to the calf. Whereas with your off-the-shelf code you fit the patient without any modifications being needed.
How does my practice bill for knee braces?
Medical practitioners are able to bill for these braces on their own patients without going through a supplier. When billing orthopedic knee bracing you want to make sure that your commercial and medicaid contracts allow you to do so. Some urgent care contracts have global billing contracts that include DME (Durable Medical Equipment) as part of that fee. However, this is not the best solution for those types of contracts. Medicare will require you to apply to become a provider supplier, which will be separate from your current Medicare billing number.
There are a few steps that will need to be taken to make sure that you are reimbursed. Once you have determined that the patient will need the knee brace. You will need to document the medical reason that the patient needs the brace, such as osteoarthritis of the knee. In addition to this most insurance companies require you to do a ligament test to prove the instability of the knee. Some insurances will require you to have a prior authorization before approving the device to be paid. Once you have documented medical necessity and obtain the prior authorization you now are able to dispense the knee brace to the patient and submit for billing. When billing you will include the KX modifier, this tells the insurance company that you have all medical documents and that medical necessity has been documented. You will also need to include RT or LT to denote what side the knee brace will be used on.
Coded Braces Available Through Brace Direct
Here is a small selection of some of the coded braces available through Brace Direct:
Benefits of Ordering Braces for Your Practice Through Brace Direct
Brace Direct takes the guesswork out of which brace is right for your patient. With the Brace Direct website you can search by code or brace, with great visuals for helping find the right sizes. To help with fitting, the Brace Direct website has videos that show you how the patient is to wear the device. If you have questions on products or fittings we have knowledgeable and trained bracing specialists to help you. For wholesale customers, Brace Direct also offers volume discounts and super fast delivery.
Have more questions? Get in touch! Our team of experts will be happy to help you with medical brace billing needs for your practice.