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Code deleted, see L1852.

Official Description

Knee orthosis (ko), 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, off-the-shelf
Short Descr Ko double upright pre ots
Coverage Carrier Priced
Pricing Indicator(s) 38 – Supplies And Surgical Dressings - Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)
MPI A – Not applicable, as HCPCS priced under one methodology
Cross-Reference(s) L1852
BETOS D1F – Prosthetic/Orthotic devices
TOS Code(s) P – Lump sum purchase of DME, prosthetics, orthotics
Added Date 10/1/2014
Termination Date 12/31/2016
APC Status Indicator Service Paid under Fee Schedule or Payment System other than OPPS
MUE Not applicable/unspecified.
MUE Not applicable/unspecified.
OTS Orthotic No
Date
Action
Notes
2017-01-01 Deleted Code deleted, see L1852.
2014-10-01 Added Added
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