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May 17, 2023

Knee Orthoses Documentation of Knee Instability Reminder

CGS wants to remind suppliers and providers that knee orthosis coverage for codes L1832, L1833, L1843, L1844, L1845, L1846, L1850, L1851, and L1852 requires 1 of 2 pathways to meet coverage criteria:

  • Recent Injury or Surgical Procedure; or
  • Ambulatory with Knee Instability
    • The treating practitioner is responsible for understanding the appropriate treatment/testing necessary based on the beneficiary's clinical presentation.
    • Medical records must include documentation of the examination of the beneficiary and an objective description of joint laxity.
      • Includes testing of the beneficiary (such as varus/valgus instability, anterior/posterior Drawer test, not all inclusive)
      • The objective test needs to show that the test resulted in an instability of the knee
    • Note: The instability of the knee joint is a result of insufficiencies in the ligaments of the knee complex. A result of instability is a separate finding from other deficits found on exam, such as a malalignment or meniscus conditions.  A subjective statement of instability or an X-Ray report would not be sufficient documentation to support the findings of knee instability.

Read the Local Coverage Determination (LCD) – Knee Orthoses (L33318)External website for full coverage details.

Publication History

May 17, 2023 Revised to include HCPCS L1850.
January 31, 2023 Originally Published


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