HCPCS Code L1812: Knee Orthosis, Elastic With Joints, Prefabricated, Off-the-Shelf

## **Documentation requirements for L1812** As with any HCPCS code, you need to follow a lot of guidelines, such as the 21st Century Cures Act, LCD-related policy articles, CMS guidelines, Medicare guidelines, and other related local coverage documents sections. You need to have a full grasp on coverage, indications, limitations, and/or medical necessities, what codes are eligible for separate payments, plus what may be denied as not reasonable and necessary. Besides all that, you also need sufficient documentation to back up a claim for any HCPCS code. Here are several of what you need for L1812: - The full name of the patient receiving the orthosis - The full name and credentials of the healthcare providers involved in assessing the patient, and the fitting and customization of the orthosis - The patient's medical history and any relevant clinical indications and diagnoses to justify the medical necessity of the orthosis - Documentation that supports any adjustments made for this orthosis, if any. If adjustments are made, descriptions of what has been done need to be detailed, and they need to have been done by a trained professional - Documentation must confirm that the device provided is off-the-shelf and requires only minimal self-adjustment (e.g., straps or closures). - Clear indication that this is a prefabricated item, not a custom-fabricated orthosis - Standard written order (SWO) or written order prior to delivery (WOPD) and proof of delivery These are also applicable to other HCPCS codes for orthoses (e.g., ones that have concentric adjustable torsion style mechanisms used, those with straps, those with flexion and extension joint technology (adjustable flexion and extension mechanisms used), codes which describe components or features, codes in the LCD applicable to you, etc.), even custom-fabricated knee orthoses (you have to be clear it's custom-fabricated, though).

## **Billing requirements for L1812** Besides the documentation requirements above, please make sure to have or take note of the following: - You have the relevant diagnosis codes based on the patient's condition (codes that support medical necessity) - Supplier records including the product model of the orthosis. - Relevant HCPCS codes besides this for knee orthosis procedures - When billing for HCPCS code L1812, use the correct modifiers to ensure accurate claim processing and coverage determination. Append RT or LT to specify the side of the body, or RTLT if both orthoses are furnished and billed on the same date of service Again, please follow guide guidelines set by your local coverage determination (LCD) and any other relevant guidelines.

## **Other similar codes** - **L1830** - Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf - **L1850** - Knee orthosis, swedish type, prefabricated, off-the-shelf - **L1834** - Knee orthosis, without knee joint, rigid, custom fabricated