|
L2040 |
 |
Hip knee ankle foot orthosis, torsion control, bilateral rotation straps, pelvic band/belt, custom fabricated
| short | Hkafo torsion bil rot straps |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| 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 |
|
|
|
|
L2050 |
|
Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, hip joint, pelvic band/belt, custom fabricated
| short | Hkafo torsion cable hip pelv |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| 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 |
|
|
|
|
L2060 |
|
Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, ball bearing hip joint, pelvic band/ belt, custom fabricated
| short | Hkafo torsion ball bearing j |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| 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 |
|
|
|
|
L2070 |
|
Hip knee ankle foot orthosis, torsion control, unilateral rotation straps, pelvic band/belt, custom fabricated
| short | Hkafo torsion unilat rot str |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| 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 |
|
|
|
|
L2080 |
|
Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, hip joint, pelvic band/belt, custom fabricated
| short | Hkafo unilat torsion cable |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| 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 |
|
|
|
|
L2090 |
|
Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, ball bearing hip joint, pelvic band/ belt, custom fabricated
| short | Hkafo unilat torsion ball br |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| 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 |
|
|
|