## **What is the HCPCS code L1906 for?**
The HCPCS code L1906 is an L code, which means it's one of many codes that mostly designate the provision of orthoses to patients. For this code, what is being provided is a prefabricated ankle-foot orthosis, specifically an off-the-shelf one. This means it is pre-made and readily available.
This specific orthosis provides multiligamentous ankle support. It stabilizes the ankle joint's ligaments across multiple areas, while still allowing free dorsiflexion and plantar flexion. It is often provided to patients who are ambulatory and have ankle instability, ankle sprains, tendonitis, ankle ligament injuries, contractures, or are undergoing rehabilitation after an injury or procedure.
Please note that this is a prefabricated item that can be obtained immediately off the shelf.
## **Documentation requirements for L1906**
As with any HCPCS code, you'll need to provide sufficient documentation when you file a claim for this code. Here are some of what you need:
- 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 for any minimal adjustments. If any adjustments are more than minimal and were done by a certified orthotist or similarly trained professional at the time of delivery, it would be considered custom-fitted, not OTS.
- Standard written order (SWO) and receipt
- Physical examination results. Imaging test results of the ankle may be included but is not a stated requirement
## **Billing requirements for L1906**
Besides the documentation requirements above, please make sure to take note of or have the following:
- You have the relevant diagnosis codes based on the patient's condition
- The use of either the RT or LT modifiers. RT for the right ankle/foot, LT for the left. If both ankles/feet require orthoses, submit two lines with RT and LT separately, each with one unit
Please make sure to follow CMS/Medicare/related coding guidelines so you can avoid claim rejections.
## **Other similar codes**
- **L2250** - Addition to lower extremity, foot plate, molded to patient model, stirrup attachment
- **L1902** - Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf
- **L1970** - Ankle foot orthosis, plastic with ankle joint, custom fabricated
- **L1940** - Ankle foot orthosis, plastic or other material, custom fabricated
- **L1960** - Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
Frequently asked questions
