HCPCS Level II Definitions and Guidelines - OptumCoding.com

HCPCS Level II Definitions and GuidelinesL3969L3980L3982L3984SEO, mobile arm support, monosuspension arm andhand support, overhead elbow forearm hand slingsupport, yoke type arm suspension support,prefabricated, includes fitting and adjustmentUpper extremity fracture orthosis, humeral,prefabricated, includes fitting and adjustmentUpper extremity fracture orthosis, radius/ulnar,prefabricated, includes fitting and adjustmentUpper extremity fracture orthosis, wrist,prefabricated, includes fitting and adjustmentOrthotic Supplies, MiscellaneousL4000 Replace girdle for spinal orthosis (CTLSO or SO)L4002 Replacement strap, any orthosis, includes allcomponents, any length, any typeCoding and Payment Guide for the Physical TherapistThis section contains national codes assigned by CMS on atemporary basis. This list contains current codes.Q codes fall under the jurisdiction of the local carrier unless theyrepresent an incidental service or are otherwise specified.Q4049Q4051Finger splint, staticSplint supplies, miscellaneous (includesthermoplastics, strapping, fasteners, padding andother supplies)Coding TipsSince Q codes are under the jurisdiction of local Medicare carriers,coverage and coding guidelines may vary.Check your Medicare carrier’s coding guidelines and coverage issuesbefore reporting services using these codes.L4350L4360Ankle control orthosis, stirrup style, rigid, includesany type interface (e.g., pneumatic, gel),prefabricated, includes fitting and adjustmentWalking boot, pneumatic, and/or vacuum, with orwithout joints, with or without interface material,prefabricated, includes fitting and adjustmentS Codes: Temporary National Codes(Non-Medicare) (S5000–S9999)Blue Cross/Blue Shield and other commercial payers develop Scodes to report drugs, services, and supplies. These codes may notbe used to bill services paid under any Medicare payment system.Medicare does not reimburse for services under S codes.L4370Pneumatic full leg splint, prefabricated, includesfitting and adjustmentS8450Splint, prefabricated, digit (specify digit by use ofmodifier)L4380L4386L4392L4394Pneumatic knee splint, prefabricated, includesfitting and adjustmentWalking boot, nonpneumatic, with or withoutjoints, with or without interface material,prefabricated, includes fitting and adjustmentReplacement soft interface material, static AFOReplace soft interface material, foot drop splintS8451S8452S8948S8990Splint, prefabricated, wrist or ankleSplint, prefabricated, elbowApplication of a modality (requiring constantprovider attendance) to one or more areas;low-level laser; each 15 minutesPhysical or manipulative therapy performed formaintenance rather than restorationL4396Static ankle foot orthosis, including soft interfacematerial, adjustable for fit, for positioning, pressurereduction, may be used for minimal ambulation,prefabricated, includes fitting and adjustmentS9131S9476Physical therapy; in the home, per diemVestibular rehabilitation program, non-physicianprovider, per diemL4398Foot drop splint, recumbent positioning device,prefabricated, includes fitting and adjustmentQ Codes: Temporary Q0000–Q9999CMS assigns Q codes to procedures, services, and supplies on atemporary basis. When a permanent code is assigned, the Q code isdeleted and cross-referenced.Coding TipS codes are not valid for reporting services performed on Medicarepatients. Before reporting services with S codes to commercialinsurance carriers, verify with your carrier that the selected code iscovered.18 ● New Codes ▲ Revised Codes MED: Medicare Reference © 2010 Ingenix