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December 21, 2023

Modifiers and Competitive Bidding Changes for Off-the-Shelf Back and Knee Braces Effective January 1, 2024

For dates of service on or after January 1, 2024, suppliers may no longer use the KV, J4, and J5 modifiers for off-the-shelf back and knee braces. Physicians and other treating practitioners, physical therapists, occupational therapists, and hospital-based suppliers used these modifiers during Round 2021 of the DMEPOS Competitive Bidding Program (CBP).

This change is a result of the Temporary Gap in CBP

All Medicare Round 2021 CBP contracts for off-the-shelf back and knee braces expire on December 31, 2023. Effective January 1, 2024, there will be a temporary gapExternal PDF in the program. Medicare-enrolled DMEPOS suppliers may furnish DMEPOS items to Medicare beneficiaries during the CBP temporary gap period.

Required Prior Authorization for HCPCS L0648, L0650, L1832, L1833, L1851

If you furnish these items during the temporary gap period you must submit a prior authorization request (expedited or standard) request.

If a beneficiary needs an item sooner than the 2-day expedited timeframe, you may use the ST modifier. Use modifier ST for Prior Authorization exceptions due to acute or emergent conditions. Orthoses Prior Authorization – What Suppliers Need to Know includes instructions for acute situations. ST modifier claims will be subject to prepayment review.

The fastest, easiest way to submit prior authorization requests is through the DME MyCGS Portal. Aside from the myCGS web portal, suppliers can submit PA requests via mailing address, fax, and esMD using the Prior Authorization (PA) Request CoversheetPDF

Required Written Order Prior to Delivery (WOPD) and Face-to-Face Encounter

The following HCPCS codes from Round 2021 CBP require a WOPD and face-to-face encounter prior to delivery: L0648, L0650, L1833, and L1851. The Required Face-to-Face Encounter and Written Order Prior to Delivery ListExternal PDF contains the entire list of HCPCS codes.


MLN Competitive Bidding Program Fact Sheets:


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