Coding Verification Review - JD DME

The only products which may be billed using the following list of HCPCS codes are those for which a written coding verification review (CVR) has been made by the PDAC contractor and subsequently published on the Product Classification List (PCL):

Prefabricated Knee Orthoses

• L1832, L1833, L1845, L1851, L1852
• L1843 - Effective for DOS on/after December 1, 2024

Prefabricated Spinal Orthoses

• L0450, L0454, L0455, L0456, L0457, L0458, L0460, L0462, L0464, L0466, L0467, L0468, L0469, L0470, L0472, L0488, L0490, L0491, L0492, L0625, L0626, L0627, L0628, L0630, L0631, L0633, L0636, L0637, L0639, L0641, L0642, L0643, L0648, L0649, L0650, L0651

Custom Fabricated Spinal Orthoses

• There are two categories of custom fabricated spinal orthoses (codes L0452, L0480, L0482, L0484, L0486, L0629, L0632, L0634, L0636, L0638, and L0640)
  • For orthoses that are custom fabricated by a manufacturer/central fabrication facility and then sent to someone other than the beneficiary. These items may be billed using one of these codes only if they are listed in the Product Classification List on the PDAC website.
  • Orthoses that are custom fabricated from raw materials and are dispensed directly to the beneficiary by the entity that fabricated the orthosis do not have to be listed on the PDAC website.

Prefabricated Ankle-Foot Orthoses

• L1951 - Effective for DOS on/after December 1, 2024