HCPCS Code L1852: Knee Orthosis (KO), Double Upright, Thigh and Calf, With Adjustable Flexion and Extension Joint, Prefabricated, Off-The-Shelf

## **What is the HCPCS code L1852 for?** The HCPCS code L1852 is meant to designate "knee orthosis (KO), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf." This orthosis is meant to provide functional support to the knee. This is often issued to patients who are dealing with knee injuries, ligament instabilities, or those recovering from a surgical procedure. What this does is that it provides adjustable flexion, extension, medial-lateral, and rotational movement, plus varus/valgus adjustment for the correction of the affected knee's alignment through its adjustable knee joints.

## **Documentation requirements for L1852** When filing claims for L1852, please ensure to have the following documentation: - The full name of the patient - The full name of the provider handling the patient - The patient's diagnosis of an ailment to justify the medical necessity of the knee orthosis (e.g., ACL tear, ligament injury, knee instability, etc.) - Clinical assessment results with information explaining the knee problem and to explain why a functional adjustable orthosis is needed instead of - Functional goals of recovery - A physician's knee orthosis standard written order prior to filing the claim - Notes on the fitting (if it's a custom-fabricated knee orthosis, there must be documentation of the modifications made for the patient)

## **Billing requirements for L1852** Besides the documentation above, please take note of the following: - This knee orthosis is for purchase, not rental - One orthosis is equal to one unit - You must provide a written order prior to delivery - Proper differentiation from off-the shelf (OTS) orthosis and custom-fitted orthosis Please follow proper CMS coding guidelines to avoid claim rejections.

## **Other similar codes** - **L1851** - Knee orthosis (KO), single upright, thigh and calf, with adjustable flexion and extension joint - **K0902** - Knee orthosis (KO), double upright, thigh and calf, with adjustable flexion and extension joint - **L1846** - Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint - **K0901** - Knee orthosis (KO), single upright, thigh and calf, with adjustable flexion and extension joint - **L1845** - Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint - **L1844** - Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint

Frequently asked questions

It can take up to an hour.

If the orthosis isn't fitted properly, the patient runs the risk of having skin irritation or pressure sores. Allergic reactions to the orthosis's materials could happen, but this should be rare.

Physical therapy. Surgery is the last resort.