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January 28, 2016

Correct Coding - IDEO™ and ExoSym™ Energy Storing AFO

Joint DME MAC Publication

The US Army developed the Intrepid Dynamic Exoskeletal Orthosis (IDEO™) in 2009. A civilian version, ExoSym™, became available in 2013. The brace provides energy storage and return capabilities that an injured ankle is no longer able to provide. Recent claim experience has demonstrated that HCPCS coding guidance for Medicare billing is necessary to prevent errors.

Based upon a review of the published clinical literature and publically-available descriptive information, the correct combination of HCPCS codes for billing IDEO™, ExoSym™ and similar braces are:

L1945 - ANKLE FOOT ORTHOSIS, PLASTIC, RIGID ANTERIOR TIBIAL SECTION (FLOOR REACTION), CUSTOM FABRICATED
L2755 - ADDITION TO LOWER EXTREMITY ORTHOSIS, HIGH STRENGTH, LIGHTWEIGHT MATERIAL, ALL HYBRID LAMINATION/PREPREG COMPOSITE, PER SEGMENT, FOR CUSTOM FABRICATED ORTHOSIS ONLY

Only HCPCS codes L1945 and L2755, in combination, may be used to bill for this type of brace. Use of the Not Otherwise Classified (NOC) HCPCS code L2999 is incorrect coding.

Refer to the Ankle Foot Orthosis / Knee Ankle Foot Orthosis (AFO/KAFO) Local Coverage Determination (LCD)External Website and related Policy ArticleExternal Website for additional information about coverage, coding and documentation.

For questions about correct coding, contact the Pricing, Data Analysis and Coding (PDAC) contractor Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact FormExternal Website.

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