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Official Description

Ankle foot orthosis, spring wire, dorsiflexion assist calf band, custom fabricated
Short Descr Afo sprng wir drsflx calf bd
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
BETOS D1F – Prosthetic/Orthotic devices
TOS Code(s) P – Lump sum purchase of DME, prosthetics, orthotics
Added Date 1/1/1986
APC Status Indicator Service Paid under Fee Schedule or Payment System other than OPPS
MUE 0
MUE 2
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
KX Requirements specified in the medical policy have been met
RT Right side (used to identify procedures performed on the right side of the body)
LT Left side (used to identify procedures performed on the left side of the body)
GA Waiver of liability statement issued as required by payer policy, individual case
KV Dmepos item subject to dmepos competitive bidding program that is furnished as part of a professional service
Date
Action
Notes
1986-01-01 Added Code added 1/1/1986
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