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January 24, 2023

Update to Required Face-to-Face Encounter and Written Order Prior to Delivery (WOPD) List Effective April 17, 2023

CMS announced the addition of 10 orthoses codes that will require a face-to-face encounter and WOPD as a condition of payment, effective for dates of service on or after April 17, 2023.

These items are in addition to the 46 power mobility devices (PMDs), 6 orthoses, and 1 osteogenesis codes that are already on the list. The new codes include the following:

HCPCS Description
L0631 Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0637 Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L1843 Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L1932 AFO, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, includes fitting and adjustment
L1940 Ankle-foot orthosis, plastic or other material, custom-fabricated
L1951 Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, includes fitting and adjustment
L1960 Ankle-foot orthosis, posterior solid ankle, plastic, custom-fabricated
L1970 Ankle-foot orthosis, plastic, with ankle joint, custom-fabricated
L2005 Knee ankle foot orthosis, any material, single or double upright, stance control, automatic lock and swing phase release, any type activation, includes ankle joint, any type, custom fabricated
L2036 Knee ankle foot orthosis, full plastic, double upright, with or without free motion knee, with or without free motion ankle, custom fabricated

Refer to the Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426)External Website for details on the order and face-to-face encounter requirements.

Learn more about these requirements on the CMS website:

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