CMS AFO LCD

Question 1

AFOs not used for ambulation (L4396 or L4397) must meet what criteria?

Answer 1

Either 1-4 or 5

1. ) PF contracture of 10
2. ) expectation to correct contracture.
3. )Contracture interferes with functioning.
4. )Used in conjunction with therapy.

5.) Plantar fasciitis

Must include ICD codes of contracture of foot or ankle or plantar fascial fibrzomatosis.

Question 2

L4631 CHARCOT boot must meet what requirements?

Answer 2

Fixed position of 0 degrees

Controls varus or valgus deformity

Contains a rocker bottom sole

Rigid anterior shell

Used by a beneficiary who is ambulatory

Has a soft interface.

Question 3

Repairs and miscellaneous

Answer 3

L4205- must include explanation of what is being repaired

L4210- include description of each item being repaired.

*an order is not necessary for the repair of an orthosis.

Question 4

For prefab orthoses what must clinical notes contain?

Answer 4

patient is ambulatory

Patient has weakness or deformity of foot or ankle

Requires stabilization for the foot and ankle for medical reasons.

patient has potential to benefit from device

Question 5

For custom orthoses, what must clinical notes contain?

Answer 5

All of the prefab requirements

Item must be molded and modified at the time of the fitting.

Requires the expertise of an orthotist.

Patient could not be fitted with prefabricated orthosis

condition must be 6 months or greater

There is a need to control knee ankle or foot in more than 1 plane.

Patient has condition that requires custom fabricating to prevent injury

Healing fracture.