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L1600 |
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Hip orthosis, abduction control of hip joints, flexible, frejka type with cover, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an inidividual with expertise
| short | Ho flex frejka w/cov pre cst |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | DME | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
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L1610 |
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Hip orthosis, abduction control of hip joints, flexible, (frejka cover only), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
| short | Ho frejka cov only pre cst |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | DME | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
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L1620 |
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Hip orthosis, abduction control of hip joints, flexible, (pavlik harness), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
| short | Ho flex pavlik harns pre cst |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | DME | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
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L1630 |
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Hip orthosis, abduction control of hip joints, semi-flexible (von rosen type), custom fabricated
| short | Abduct control hip semi-flex |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | DME | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
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L1640 |
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Hip orthosis, abduction control of hip joints, static, pelvic band or spreader bar, thigh cuffs, custom fabricated
| short | Pelv band/spread bar thigh c |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | DME | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
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L1650 |
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Hip orthosis, abduction control of hip joints, static, adjustable, (ilfled type), prefabricated, includes fitting and adjustment
| short | Ho abduction hip adjustable |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | DME | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
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L1652 |
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Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, includes fitting and adjustment, any type
| short | Ho bi thighcuffs w sprdr bar |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | DME | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
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L1660 |
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Hip orthosis, abduction control of hip joints, static, plastic, prefabricated, includes fitting and adjustment
| short | Ho abduction static plastic |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | DME | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
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L1680 |
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Hip orthosis, abduction control of hip joints, dynamic, pelvic control, adjustable hip motion control, thigh cuffs (rancho hip action type), custom fabricated
| short | Pelvic & hip control thigh c |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | DME | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
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L1685 |
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Hip orthosis, abduction control of hip joint, postoperative hip abduction type, custom fabricated
| short | Post-op hip abduct custom fa |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
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L1686 |
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Hip orthosis, abduction control of hip joint, postoperative hip abduction type, prefabricated, includes fitting and adjustment
| short | Ho post-op hip abduction |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
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L1690 |
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Combination, bilateral, lumbo-sacral, hip, femur orthosis providing adduction and internal rotation control, prefabricated, includes fitting and adjustment
| short | Combination bilateral ho |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | DME | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
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