CGS wants to remind suppliers and providers that knee orthosis coverage for codes L1832, L1833, L1843, L1844, L1845, L1846, L1851, and L1852 requires 1 of 2 pathways to meet coverage criteria:
Recent injury or surgical procedure or ambulatory with knee instability:
- The treating practitioner is responsible for understanding the appropriate treatment/testing necessary based on the beneficiary’s clinical presentation.
- Medical records must include documentation of the examination of the beneficiary and an objective description of joint laxity.
- Includes testing of the beneficiary (such as varus/valgus instability, anterior/posterior Drawer test, not all inclusive)
- The objective test needs to show that the test resulted in an instability of the knee
- Note: The instability of the knee joint is a result of insufficiencies in the ligaments of the knee complex. A result of instability is a separate finding from other deficits found on exam, such as a malalignment or meniscus conditions. A subjective statement of instability or an X-Ray report would not be sufficient documentation to support the findings of knee instability.
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