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L2750 |
 |
Addition to lower extremity orthosis, plating chrome or nickel, per bar
| short | Plating chrome/nickel pr bar |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 8.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 8.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
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L2755 |
|
Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only
| short | Carbon graphite lamination |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 8.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 8.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
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L2760 |
|
Addition to lower extremity orthosis, extension, per extension, per bar (for lineal adjustment for growth)
| short | Extension per extension per |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 8.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | DME | 8.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
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L2768 |
|
Orthotic side bar disconnect device, per bar
| short | Ortho sidebar disconnect |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 4.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | DME | 4.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
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L2780 |
|
Addition to lower extremity orthosis, non-corrosive finish, per bar
| short | Non-corrosive finish |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 8.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 8.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
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L2785 |
|
Addition to lower extremity orthosis, drop lock retainer, each
| short | Drop lock retainer each |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 4.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | DME | 4.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
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L2795 |
|
Addition to lower extremity orthosis, knee control, full kneecap
| short | Knee control full kneecap |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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L2800 |
|
Addition to lower extremity orthosis, knee control, knee cap, medial or lateral pull, for use with custom fabricated orthosis only
| short | Knee cap medial or lateral p |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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L2810 |
|
Addition to lower extremity orthosis, knee control, condylar pad
| short | Knee control condylar pad |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 4.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 4.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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L2820 |
|
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section
| short | Soft interface below knee se |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Anatomic Consideration | | DME | 2.0 | 3 Date of Service Edit: Clinical | Anatomic Consideration |
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L2830 |
|
Addition to lower extremity orthosis, soft interface for molded plastic, above knee section
| short | Soft interface above knee se |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Anatomic Consideration | | DME | 2.0 | 3 Date of Service Edit: Clinical | Anatomic Consideration |
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L2840 |
|
Addition to lower extremity orthosis, tibial length sock, fracture or equal, each
| short | Tibial length sock fx or equ |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Published Contractor Policy |
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L2850 |
|
Addition to lower extremity orthosis, femoral length sock, fracture or equal, each
| short | Femoral lgth sock fx or equa |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Published Contractor Policy |
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L2861 |
|
Addition to lower extremity joint, knee or ankle, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each
| short | Torsion mechanism knee/ankle |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Published Contractor Policy |
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L2999 |
|
Lower extremity orthoses, not otherwise specified
| short | Lower extremity orthosis nos |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
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