HCPCS Code L4397: Static or Dynamic Ankle Foot Orthosis, Including Soft Interface Material, Adjustable for Fit, for Positioning, May Be Used for Minimal Ambulation, Prefabricated, Off-the-Shelf

Learn about the HCPCS code L4397 for a prefabricated static or dynamic ankle foot orthosis through this guide.

## **What is the HCPCS code L4397 for?** The HCPCS code L4397 is meant to designate the provision of a prefabricated and off-the-shelf ankle-foot orthosis (AFO). This specific orthosis can be static or dynamic. It also includes soft interface material and is adjustable for a comfortable fit for the patient. This specific orthosis is made primarily for positioning and supportive care, with only minimal ambulation. It's provided for the following purposes: contracture management, joint positioning therapy, light-weight-bearing support, and post-surgical stabilization. The goal of using this device is to provide stabilization, improve mobility over time, prevent any deformities from forming, and make rehabilitation smoother. Healthcare professionals normally provide this orthosis to patients with the following problems: - Foot drops - Ankle instability - Ankle and/or foot injuries - Lower limb paralysis - Multiple sclerosis - Plantar fasciitis - Cerebral palsy - Those recovering from a stroke that affected the lower extremities Please note that this is a prefabricated orthosis, not custom-fabricated/custom fit.

## **Documentation requirements for L4397** Just like with any HCPCS code, please make sure to brush up on relevant coding guidelines and have sufficient documentation, such as the following: - 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 fitting 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 the adjustment of the orthosis for the patient, if any. If there are, the adjustments must have been done by a certified orthotist or similarly trained professional at the time of provision - Documented measurable non-plantar flexion contractures - Stretching therapy plan - Standard written order (SWO) and receipt - Ankle/foot imaging test results (X-rays, MRIs, etc.)

## **Billing requirements for L4397** Besides the documentation 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 - Clear identification that this is prefabricated and off-the-shelf - Use the KX modifier if all documentation and coverage criteria (as per LCD) are met. If criteria are unmet, but an Advance Beneficiary Notice is signed, use GA; if not, use GZ. Claims without the right modifier risk being rejected - If the device is part of a replacement interface (e.g., L4394), coverage is permissible (once every six months) only if the patient continues to meet original indications Please make sure to follow all the necessary guidelines and related policy articles to avoid claim rejections.

## **Other similar codes** There are several similar codes for similar orthoses, such as night splints, orthoses meant for malformed body members, lower limb orthoses, etc. Here are some of them: - **L4398** - Foot drop splint, recumbent positioning device, prefabricated, off-the-shelf - **L4631** - Ankle foot orthosis, walking boot type, varus/valgus correction, rocker bottom, anterior tibial shell, soft interface, custom arch support, plastic or other material, includes straps and closures, custom fabricated - **L4394** - Replace soft interface material, foot drop splint - **L3100** - Hallus-valgus night dynamic splint, prefabricated, off-the-shelf

Frequently asked questions

It can take up to an hour, especially if there are adjustments or add-ons.

Prolonged use of this orthosis will lead to skin irritation and the emergence of pressure ulcers. It's best to make sure the patient follows instructions regarding how long they should wear it each day.

The patient should feel it immediately, even just a little bit. They will continue to gradually feel the positive impact of this orthosis over time.