|
L2180 |
 |
Addition to lower extremity fracture orthosis, plastic shoe insert with ankle joints
| short | Plas shoe insert w ank joint |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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|
|
|
L2182 |
|
Addition to lower extremity fracture orthosis, drop lock knee joint
| short | Drop lock knee |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 4.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | DME | 4.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
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|
|
|
L2184 |
|
Addition to lower extremity fracture orthosis, limited motion knee joint
| short | Limited motion knee joint |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 4.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | DME | 4.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
L2186 |
|
Addition to lower extremity fracture orthosis, adjustable motion knee joint, lerman type
| short | Adj motion knee jnt lerman t |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 4.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | DME | 4.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
L2188 |
|
Addition to lower extremity fracture orthosis, quadrilateral brim
| short | Quadrilateral brim |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
|
|
|
|
L2190 |
|
Addition to lower extremity fracture orthosis, waist belt
| short | Waist belt |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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|
|
|
L2192 |
|
Addition to lower extremity fracture orthosis, hip joint, pelvic band, thigh flange, and pelvic belt
| short | Pelvic band & belt thigh fla |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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