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SPECIAL REPORT - January 21, 1999

New 1999 HCPCS Codes/Deletions and Fee Schedule Allowances

 The following are the new HCPCS codes for 1999. These went into effect on January 1, 1999. The information is organized in the following order:

Following the new codes are the HCPCS codes that were deleted, as of January 1, 1999 and information regarding alternative coding.   
The last item enclosed is a list of the 1999 Medicare fee schedule allowances for the new codes.

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New Code: L1690
Descriptor: Combination, bilateral, lumbo-sacral, hip, femur orthosis providing adduction and internal rotation control
Interpretation: A custom-fitted bilateral hip control orthosis which offers combined adduction and rotational guidance.
Example: Standing Walking and Sitting Hip Orthosis (SWASH) by Camp


New Code: L1847
Descriptor: Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s)
Interpretation: A custom-fitted double bar knee orthosis with inflatable pads and adjustable joints with pneumatic extension assist feature, which can limit range of knee motion in the saggital plane.
Example: Pucci Knee Orthosis by DMannco, Inc.


New Code: L3675
Descriptor: SO, vest type abduction restrainer, canvas webbing type, or equal
Interpretation: A vest style orthosis which limits shoulder abduction, made of canvas or similar material.
Example: Duke Wyre Shoulder Orthosis by C.D. Denison Co.


New Code: L5968
Descriptor: All lower extremity prosthesis, ankle, multiaxial shock absorbing system
Interpretation: An ankle that provides motion in all directions during walking and standing and actively dorsiflexes and returns to its original position when unloaded.
Example: R-HAB Ankle by Rincoe and Associates


New Code: L5975
Descriptor: All lower extremity prosthesis, combination single axis ankle and flexible keel foot
Interpretation: An addition to a lower limb prosthesis that combines a unicentric ankle and a flexible keel forefoot providing limited plantar and dorsiflexion and improved compliance with irregular ground contours.
Example: DYCOR Geriatric ADL Single Axis Foot by Knit-Rite, Inc.


New Code: L5988
Descriptor: All lower extremity prosthesis, combination vertical shock and multiaxial rotation/torsional force reducing pylon
Interpretation: A pylon to be used with a variety of feet, which upon weight bearing will deflect vertically and return to its original posture when unloaded plus provide a controlled axial rotation component.
Example: TT Pylon by Endolite, Ultimate Pylon by USMC


New Code L6693
Descriptor: Upper extremity addition, external locking elbow, forearm counterbalance
Interpretation: Addition to upper limb prosthesis of an externally locking elbow with an integral forearm which contains an adjustable forearm counterbalance device to compensate for T.D. weight or lack of force/excursion of residiuum to obtain forearm flexion and extension.
Example: 12K33 Automatic Forearm Balance Elbow by Otto Bock


New Code: L8015
Descriptor: External breast prosthesis garment with mastectomy form, post mastectomy
Interpretation: A bra which includes a light weight breast form for use soon after mastectomy or whenever conventionally weighted breast forms are not appropriate.


New Code: L8035
Descriptor: Custom breast prosthesis, post mastectomy, molded to patient model
Interpretation: An external breast prosthesis custom made from an impression of the patients chest wall and remaining breast.
Example: Custom breast prosthesis by BioPortraits from Otto Bock


New Code: L8195
Descriptor: Gradient compression stocking, waist length, 30-40 MMHG, each
Interpretation: A foot to waist elastic garment with gradient compression that decreases proximally, providing a maximum pressure equal to 30 to 40 millimeters of mercury.

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1999 Deleted HCPCS Codes

Deleted Code: L4310
Descriptor: Multipodus or equal orthotic preparatory management system for lower extremities
Interpretation: We have been informed by the DMERCs that L4396 is the replacement code for L4310. If you bill for L4310, it will be changed to L4396 and paid at the L4396 allowance


Deleted Code: L4320
Descriptor: Addition to AFO, multipodus (or equal) orthotic preparatory management system for lower extremities, flexible foot positioner with soft interface for AFO, with velcro closure
Interpretation: According to the DMERCs, L4392 is the replacement for L4320.


DeletedCode: L4390
Descriptor: Replace soft interface material, multipodus type splint
Interpretation: According to the DMERCs, L4392 is the replacement for L4390.

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1999 Orthotics and Prosthetics Medicare Fee Schedule

Supplement of New Codes

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Questions and Comments

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