Article Detail - JA DME

Knee orthosis coverage for codes L1832, L1833, L1843, L1844, L1845, L1846, L1851, and L1852 requires one of two pathways to meet coverage criteria:

• Recent injury or surgical procedure; or
• Ambulatory beneficiary with knee instability
• The treating practitioner is responsible for understanding the appropriate treatment/testing necessary based on the beneficiary's condition.
• Medical records must include documentation of the examination and an objective description of joint laxity.
  • Includes testing of the beneficiary (such as varus/valgus instability, anterior/posterior Drawer test, not all inclusive)
  • The objective test must show the test resulted in instability of the knee
  • A subjective statement of instability would not be sufficient documentation to support knee instability.

The Knee Orthoses Local Coverage Determination (L33318) has full coverage details.