PDAC Revises Definitions for L1906, Removes Height Requirement

Seeking consistency with the DME MAC LCD Policy Article released on January 1, 2013, the Pricing Data Analysis and Coding contractor (PDAC) has revised definitions for L1906, removing a key height requirement that had caused significant issues for prosthetists. Below is the updated definition for L1906 effective for claims filed after April 1, 2012. 

L1906 Ankle Foot Orthoses, Multiligamentous Ankle Support, Prefabricated, Includes Fitting and Adjustment A multiligamentous ankle support provides control of the ankle joint between the medial and lateral malleoli while allowing for dorsiflexion and plantar flexion. This off-the-shelf ankle support includes a rigid stirrup and foot plate which provides functional tracking of the ankle with hind-foot and mid-foot stability during ambulation. This, in conjunction with wrap-around straps and the inherent gauntlet design, offers areas of multiligamentous support as described by the code. There are no additional HCPCS codes for this type of prefabricated ankle orthosis.

L1960 Ankle Foot Orthoses, Posterior Solid Ankle, Plastic, Custom Fabricated — An Ankle Foot Orthosis (AFO) provides ankle control for patients with musculoskeletal or neuromuscular dysfunction. The AFO is designed to provide rigid immobilization of the ankle-foot complex in the sagittal, coronal, and transverse planes. The custom fabricated solid ankle AFO can be constructed from thermosetting materials, thermoplastics, or composite type materials.

Questions on the revised definitions can be directed to the PDAC Contact Center at (877) 735-1326.

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