Ankle-Foot Orthosis (AFO) (HCPCS L1940, L1970 & L4361) Notification of Service Specific Post-Payment Review

Noridian Jurisdiction D, DME MAC, Medical Review is initiating service specific post-payment medical record review of claims for the following HCPCS codes:

  • L1940: ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL, CUSTOM-FABRICATED
  • L1970: ANKLE FOOT ORTHOSIS, PLASTIC WITH ANKLE JOINT, CUSTOM-FABRICATED
  • L4361: WALKING BOOT, PNEUMATIC AND/OR VACUUM, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, PREFABRICATED, OFF-THE-SHELF

Service specific reviews are initiated to prevent improper payments for services which present possible sustained or high-level payment errors. This review is being initiated based on data analysis identifying probable vulnerabilities.

Please see the Medical Record Review Results page for further information.

 

Last Updated Dec 07 , 2020