HCPCS Code L4396: Static or Dynamic Ankle Foot Orthosis

## **What is the HCPCS code L4396 for?** The HCPCS code L4396 is meant to designate "static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise." This type of foot orthotic is designed to either provide stability to an ankle or to help the beneficiary with walking. Even though it's prefabricated, it can be adjusted and customized based on the patient's needs (e.g., adding shoe inserts, use of molded plastic, etc.). This can take the form of night splints, foot drop splints, ankle contracture splints, and more, depending on the patient's needs and the specific diseased or injured part/malformed body member. This orthotic is normally issued to patients with: - Foot drops - Achilles tendonitis - Plantar fascia problems like plantar fasciitis or plantar flexion contracture - Heel pain - Weakness of the foot/ankle - Paralysis of the foot/ankle - Deformities due to certain injuries/diseases

## **Documentation requirements for L4396** Before filing for a claim for L4396, please make sure you have sufficient documentation: - The full name of the patient receiving the ankle foot orthosis - The full name and credentials of the healthcare providers involved in assessing the patient, and the fitting and customization of the ankle foot orthosis - The patient's medical history and any relevant clinical indications and diagnoses to justify the medical necessity of the ankle foot orthosis - Documentation that supports the substantial modification of the orthosis for the patient, and a certified orthotist did that customization or similarly trained professional at the time of delivery - Standard written order (SWO) or written order prior to delivery (WOPD) and proof of delivery - Ankle/foot imaging test results (X-rays, MRIs, etc.) - Advance beneficiary notice (ABN) - Patient treatment plans outside of the use of the ankle foot orthosis Please make sure that documentation aligns with the specifications mandated by any applicable Local Coverage Determination (LCD) for upper limb orthoses or the Medicare Program Integrity Manual.

## **Billing requirements for L4396** Besides the documentation requirements above, please make sure to prepare and take note of 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, LT for the left. If both wrists require orthoses, submit two lines with RT and LT separately, each with one unit - Use the **KX** modifier if all LCD coverage criteria have been met and documented. If not, use the **GA** modifier if you have an advance beneficiary notice (ABN), or **GZ** if there's no ABN - Make sure to be clear if modifications and custom fits were made Please follow CMS/relevant coding guidelines to avoid claim rejections.

## **Other similar codes** - **L2106** - Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, thermoplastic type casting material, custom fabricated - **L2108** - Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, custom fabricated - **L2112** - Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment - **L2114** - Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment - **L2116** - Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, rigid, prefabricated, includes fitting and adjustment

Frequently asked questions

It usually takes anywhere from 30 minutes to an hour.

Orthotists are responsible for fitting and providing orthotics. They will rely on information provided by orthopedic specialists and physical therapists to determine the best model or customizations to be provided.

It's normal for patients to experience discomfort in their ankle/foot as they adjust to the new fit. However, if the discomfort persists, it indicates that the fitting wasn't done correctly and needs to be addressed. Also, prolonged use of the orthosis could lead to skin irritations or, worse, pressure sores, so the foot/ankle must be checked regularly. It's also possible, though rare, to have an allergic reaction to the materials used to make the orthosis. This needs immediate attention if it does happen.