Durable Medical Equipment Coding System (DMECS)

HCPCS Code L1845 Details

Short Description: KO DOUBLE UPRIGHT PRE CST

Long Description: KNEE ORTHOSIS, DOUBLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND EXTENSION JOINT (UNICENTRIC OR POLYCENTRIC), MEDIAL-LATERAL AND ROTATION CONTROL, WITH OR WITHOUT VARUS/VALGUS ADJUSTMENT, PREFABRICATED ITEM THAT HAS BEEN TRIMMED, BENT, MOLDED, ASSEMBLED, OR OTHERWISE CUSTOMIZED TO FIT A SPECIFIC PATIENT BY AN INDIVIDUAL WITH EXPERTISE

Additional Search Terminology:

Product and Service Code(s): OR02 : ORTHOSES: PREFABRICATED (CUSTOM FITTED).

References: Local Coverage Determination (LCD) for Knee Orthoses, Local Coverage Article for Knee Orthosis - Policy Article

Fee Schedules

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Product Classification

View reviewed products on the DMEPOS Product Classification List for this code

Code History

Effective Date	Type	Notes
01/01/1988	Added to HCPCS Code Set
10/01/1993	Valid for DME MAC submission
01/01/2001	Long Description Change	Old Long Description: - KO, DOUBLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND EXTENSION JOINT, MEDIAL-LATERAL AND ROTATION CONTROL, CUSTOM FITTED
01/01/2006	Long Description Change	Old Long Description: - KNEE ORTHOSIS, DOUBLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND EXTENSION JOINT, MEDIAL-LATERAL AND ROTATION CONTROL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
01/01/2014	Long Description Change	Old Long Description: - KNEE ORTHOSIS, DOUBLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND EXTENSION JOINT (UNICENTRIC OR POLYCENTRIC), MEDIAL-LATERAL AND ROTATION CONTROL, WITH OR WITHOUT VARUS/VALGUS ADJUSTMENT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

Crosswalk History

Effective Date	From Code	To Code	Notes

Features and Functions

Features & Functions	Images
A prefabricated knee orthosis, customized to fit a specific patient by an individual with expertise. Code L1845 includes: Double uprights, Condylar pads, Adjustable flexion and extension joint, Both medial-lateral and rotation control. -Medial-lateral control of the knee is provided by the solid metal double uprights. -Rotation control is provided by the combination of solid metal in the anterior portion of the thigh and calf cuffs, and condylar pads. These are designed for patients who are fully ambulatory. An orthosis (brace) is: Rigid or semi-rigid device which is used for the purpose of supporting a weak or deformed body member or restricting or eliminating motion in a diseased or injured part of the body Must provide support and counterforce (i.e., a force in a defined direction of a magnitude at least as great as a rigid or semi-rigid support) on the limb or body part being braced. Custom fitted orthotics are: Prefabricated Devices. May or may not be supplied as a kit that requires some assembly. Assembly of the item and/or installation of add-on components and/or the use of some basic materials in preparation of the item does not change classification from OTS to custom fitted. Classification as custom fitted requires substantial modification for fitting at the time of delivery in order to provide an individualized fit, i.e., the item must be trimmed, bent, molded (with or without heat), or otherwise modified resulting in alterations beyond minimal self-adjustment. Requires fitting at delivery be a person with expertise such as a certified orthotist or an individual who has equivalent specialized training in the provision of orthoses to fit the item to the individual beneficiary. Substantial modification is defined as changes made to achieve an individualized fit of the item that requires the expertise of a certified orthotist or an individual who has equivalent specialized training in the provision of orthotics such as a physician, treating practitioner, an occupational therapist, or physical therapist in compliance with all applicable Federal and State licensure and regulatory requirements.

Features & Functions

Images

A prefabricated knee orthosis, customized to fit a specific patient by an individual with expertise.

Code L1845 includes:

Double uprights,
Condylar pads,
Adjustable flexion and extension joint,
Both medial-lateral and rotation control. -Medial-lateral control of the knee is provided by the solid metal double uprights. -Rotation control is provided by the combination of solid metal in the anterior portion of the thigh and calf cuffs, and condylar pads.

These are designed for patients who are fully ambulatory.

An orthosis (brace) is:

Rigid or semi-rigid device which is used for the purpose of supporting a weak or deformed body member or restricting or eliminating motion in a diseased or injured part of the body
Must provide support and counterforce (i.e., a force in a defined direction of a magnitude at least as great as a rigid or semi-rigid support) on the limb or body part being braced.

Custom fitted orthotics are:

Prefabricated Devices.
May or may not be supplied as a kit that requires some assembly. Assembly of the item and/or installation of add-on components and/or the use of some basic materials in preparation of the item does not change classification from OTS to custom fitted.
Classification as custom fitted requires substantial modification for fitting at the time of delivery in order to provide an individualized fit, i.e., the item must be trimmed, bent, molded (with or without heat), or otherwise modified resulting in alterations beyond minimal self-adjustment.
Requires fitting at delivery be a person with expertise such as a certified orthotist or an individual who has equivalent specialized training in the provision of orthoses to fit the item to the individual beneficiary.

Substantial modification is defined as changes made to achieve an individualized fit of the item that requires the expertise of a certified orthotist or an individual who has equivalent specialized training in the provision of orthotics such as a physician, treating practitioner, an occupational therapist, or physical therapist in compliance with all applicable Federal and State licensure and regulatory requirements.