Updated Billing Instructions for L1820 and L1652 Approved

Centers for Medicare and Medicaid Services (CMS) approved the creation of two off-the-shelf (OTS) codes that previously only had “custom fitted” code. Prior to the creation of the new codes, suppliers furnishing off-the-shelf equivalent of HCPCS code L1820 Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, includes fitting and adjustment and L1652 Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, includes fitting and adjustment, any type, would have to bill Medicare with the miscellaneous code L2999. Effective dates of service on or after October 01, 2024, suppliers are no longer allowed to bill the miscellaneous code L2999 when billing for the OTS codes for L1820 and L1652. Instead, supplier must bill HCPCS code L1821 Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, off the shelf and L1653 Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, off the shelf respectively.

Please ensure you notify your billing staff of this change to avoid any denials and delays in payment. Claims with dates of service on or after October 01, 2024, billed with the miscellaneous code for these two items will be denied. Suppliers will have the opportunity to update the HCPCS code and resubmit the claim for payment. Claims with a date of service prior to October 01, 2024, must be submitted with the miscellaneous code and all required information for processing.

Effective October 01, 2024, CMS also revised the narrative description on HCPCS code L1820 and L1652 to reflect “to fit a specific patient by an individual with expertise” The full narrative description now reads:

L1820 – KNEE ORTHOSIS, ELASTIC WITH CONDYLAR PADS AND JOINTS, WITH OR WITHOUT PATELLAR CONTROL, PREFABRICATED ITEM THAT HAS BEEN TRIMMED, BENT, MOLDED, ASSEMBLED, OR OTHERWISE CUSTOMIZED TO FIT A SPECIFIC PATIENT BY AN INDIVIDUAL WITH EXPERTISE

L1652 – HIP ORTHOSIS, BILATERAL THIGH CUFFS WITH ADJUSTABLE ABDUCTOR SPREADER BAR, ADULT SIZE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT, PREFABRICATED ITEM THAT HAS BEEN TRIMMED, BENT, MOLDED, ASSEMBLED, OR OTHERWISE CUSTOMIZED TO FIT A SPECIFIC PATIENT BY AN INDIVIDUAL WITH EXPERTISE

If you have additional questions or concerns, please do not hesitate to contact Noel Neil directly at [email protected].