HCPCS Code L1902: Ankle Orthosis, Ankle Gauntlet or Similar, With or Without Joints, Prefabricated, Off-the-Shelf

L1902 is appropriate for patients with ambulatory weakness, injury, deformity, or instability of the ankle that requires stabilization or motion restriction. Documentation must show medical necessity and functional benefit. Custom-fabricated devices should be used only when the patient’s anatomy or condition cannot be managed with a prefabricated, off-the-shelf option.

Yes. A standard written order (SWO) must be on file before supplying the device. A face-to-face (F2F) encounter with the treating practitioner is also required for all orthoses, unless specific payer policy states otherwise.

No. Suppliers must confirm that the same or a similar orthosis has not been provided to the patient within the device’s reasonable useful lifetime (typically 5 years). If coverage is unlikely, issue an Advance Beneficiary Notice (ABN) before dispensing.