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Article Detail - JA DME

Knee Orthoses - Correct Documentation of Knee Instability

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.


            Last Updated Thu, 13 Apr 2023 19:12:47 +0000