2018 medicare reimbursement schedule the medicare...
TRANSCRIPT
L Codes2018 Ceiling & Floor
Reimbursement
Style & Reimbursement Guide
GAUNTLET SPECIALTY COLLECTION THERMOPLASTIC
Ariz
ona
Brac
e® -
Sta
ndar
d
AZ
Bree
zeTM
Ariz
ona
Brac
e® -
Tal
l
AZ
Spor
tyTM
Moo
re B
alan
ce B
race
(MBB
)TM
AZ
Slim
TM
Ariz
ona
Mez
zoTM
Mez
zo w
ith P
artia
l Foo
tTM
Ariz
ona
Brac
e® -
Ext
ende
d
Ariz
ona
Brac
e® -
Unw
eigh
ted
Ariz
ona
Brac
e® -
Art
icul
ated
Clo
sed
Toe
Wal
kerTM
Ope
n To
e W
alke
rTM
EC
Neu
row
alke
rTM
Par
tial F
oot A
FOTM
Par
tial F
oot W
alke
rTM
The
rmop
last
ic A
FO
The
rmop
last
ic A
FO -
Art
icul
ated
Sup
ra M
alle
olar
Ort
hosi
s
AZ
Crow
Wal
kerTM
Ariz
ona
Opt
ima
Brac
eTM
Spl
it U
prig
ht
L1940 $598.41-$448.81 • • • • • • •
L1960 $670.70 -$503.02 • • • • • •
L1970 $861.01-$645.75 • • • •
L2330 $475.12-$356.34 • • • • • • • • • • • • • • • •
L2820 $105.08 -$78.81 • • • • • • • • • • • • • • • •
L5000 $651.34-$488.50 • • •
L2210 $81.33-$61.00
L3400 $47.05-$35.29 • • • • •
L4631 $1782.90-$1337.17 •
L1907 $650.49-$487.87 • • •
L1904 $569.00-$426.75 •
Totals
$ 117
8.61
- $ 8
83.9
1
$ 117
8.61
- $ 8
83.9
1
$ 117
8.61
- $ 8
83.9
1
$ 117
8.61
- $ 8
83.9
1
$ 117
8.61
- $ 8
83.9
1
$ 114
9.20
- $ 8
61.9
0
$ 112
5.61
- $ 8
44.2
1
$ 177
6.95
- $ 1
332.
71
$ 125
0.90
- $ 9
38.1
7
$ 125
0.90
- $ 9
38.1
7
$ 144
1.21
- $ 1
080.
90
$ 129
7.95
- $ 9
73.4
6
$ 129
7.95
- $ 9
73.4
6
$ 129
7.95
- $ 9
73.4
6
$ 182
9.95
- $ 1
372.
46
$ 187
7 - $ 1
407.
75
$ 670
.70
- $ 5
03.0
2
$ 861
.01
- $ 6
45.7
5
$ 697
.54 -
$ 523
.16
$ 178
2.90
- $ 1
337.
17
$ 966
.09 -
$ 724
.56
$ 966
.09 -
$ 724
.56
2018 MEDICARE REIMBURSEMENT SCHEDULE FOR STANDARD & CUSTOM STYLES
The Medicare L Code floor and ceiling allowables reflect the variance by state. The reimbursement rates listed are for reference only.
The Standard, Tall, Unweighting, Extended and Partial Foot AFOs have been reviewed by Medicare and the L codes listed are what are suggested. The other product styles have not been reviewed and the final and sole responsibility for the correct coding, within established laws, rules and standards of practice, rest upon the party submitting the claim.
*L2210 may be used on articulated styles that utilize dorsi-flexion assist joint.
110117_ArizonaAFO-Quick Reference Guide.indd 1 1/15/2018 9:36:38 AM
ARIZONA AFO QUICK REFERENCE GUIDE
ARIZONA STANDARD BRACE®
Clinical Indications:• PTTD (Posterior Tibial Tendon Dysfunction)• Talocalcaneal varus or valgus• Tibialis tendonitis (posterior or anterior)• Severe pronation or pes planus• Ankle arthritis or Degenerative Joint Disease (DJD)• Charcot foot• Ankle, subtalar or midtarsal trauma• Chronic Achilles tendonitis
Suggested L Codes: L1940, L2330, L2820
ARIZONA BRACE® - TALLClinical Indications:• PTTD (Posterior Tibial Tendon Dysfunction)• Talocalcaneal varus or valgus• Tibialis tendonitis (posterior or anterior)• Severe pronation or pes planus• Ankle arthritis or Degenerative Joint Disease (DJD)• Charcot foot• Ankle, subtalar or midtarsal trauma• Chronic Achilles tendonitis
Suggested L Codes: L1940, L2330, L2820
ARIZONA BRACE® - EXTENDEDClinical Indications:• Post fractures of the distal tibia• Post fractures of the ankle, subtalar
and midtarsal trauma• Charcot foot• Severe ankle instability• Post fractures of the distal tibia
Suggested L Codes: L1960, L2330, L2820
ARIZONA BRACE® - UNWEIGHTINGClinical Indications:• Post fractures of the distal tibia• Post fractures of the ankle, subtalar
and midtarsal trauma• Following reconstructive orthopedic surgery
after crushing injuries to the midfoot and hindfoot• Ankle arthritis or Degenerative Joint Disease (DJD)• Charcot foot• Severe ankle instability•
Suggested L Codes: L1940, L2330, L2820
ARIZONA BRACE® - ARTICULATEDClinical Indications:• Mild Posterior Tibial Tendon Dysfunction (PTTD)• Mild to moderate Degenerative Joint Disease (DJD)• Talocalcaneal varus or valgus• Ankle instability• Mild to moderate pronation• Charcot foot• Paralytic equinus or drop foot• Trauma
Suggested L Codes: L1970, L2330, L2820
AZ SPORTYTM
Clinical Indications:• Sports injuries, such as chronic ankle sprains• Less severe conditions that do not require support
for the medial longitudinal arch
Suggested L Codes: L1940, L2330, L2820
AZ BREEZETM
Clinical Indications:• Posterior Tibial Tendon Dysfunction (PTTD)• Talocalcaneal varus or valgus• Tibialis tendonitis (posterior or anterior)• Severe pronation or pes planus• Ankle arthritis or Degenerative Joint Disease (DJD)• Charcot foot• Ankle, subtalar or midtarsal trauma• Chronic Achilles tendonitis
Suggested L Codes: L1940, L2330, L2820
AZ SLIMTM
Clinical Indications:• Ankle instability (Note: No plastic inner shell, all leather gauntlet)
Suggested L Codes: L1904, L2330, L2820
MOORE BALANCE BRACE (MBB)TM
Clinical Indications:• Difficulty walking and/or maintaining balance • Chronic ankle Instability • Arthritic ankle
Suggested L Codes: L1940, L2330, L2820
ARIZONA MEZZOTM
Clinical Indications:• Posterior Tibial Tendon Dysfunction (PTTD) Stages 1 & 2• Sinus Tarsi Syndrome• Hypotonia/low tone• Peroneal tendonitis• Plantar fasciitis• Ankle, subtalar or midtarsal trauma• Osteoarthritis of the subtalar and midtarsal joints
Suggested L Codes: L1907, L2330
EC NEUROWALKERTM
Clinical Indications:• Charcot foot and ankle• Post fractures of the distal tibia• Neuropathic conditions of the ankle and foot • Severe ankle instability
Suggested L Codes: L1960, L2330, L2820, L3400
PARTIAL FOOT AFOTM
Clinical Indications:• Trans-metatarsal amputation• Chopart’s amputations• Syme’s amputations
Suggested L Codes: L1940, L2330, L2820, L5000
PARTIAL FOOT WALKERTM
Clinical Indications:Abnormally sized and/or shaped feet and ankles in conjunction with the indications listed for the Standard and Tall Arizona Brace®.• Trans-metatarsal amputations• Chopart’s amputation• Syme’s amputation
Suggested L Codes: L1960, L2330, L2820, L5000, L3400
CLOSED TOE WALKERTM
Clinical Indications:Abnormally sized and/or shaped feet and ankles in conjunction with the indications listed for the Standard and Tall Arizona Brace®.• Posterior Tibial Tendon Dysfunction (PTTD)• Talocalcaneal vargus or valgus• Tibial tendonitis• Severe pronation or pes planus• Ankle arthritis or Degenerative Joint Disorder (DJD)• Charcot foot• Chronic Achilles tendonitis• Ankle, subtalar or midtarsal trauma
Suggested L Codes: L1960, L2330, L2820, L3400
OPEN TOE WALKERTM
Clinical Indications:• Foot drop• Arthritic abnormalities• Ankle arthritis or Degenerative
Joint Disease (DJD)• Abnormal foot shapes
Suggested L Codes: L1960, L2820, L2330, L3400
ARIZONA OPTIMA BRACETM
Clinical Indications:• Mild to moderate Posterior
Tibial Tendon Dysfunction (PTTD) • Chronic ankle instability
Suggested L Codes: L1970, L2820
SPLIT UPRIGHTClinical Indications:• Posterior Tibial Tendon
Dysfunction (PTTD)• Lateral & medial instability
of subtalar joint• Chronic ankle instability • Severe pronation• Sinus tarsi syndrome• Trauma
Suggested L Codes: L1970, L2820
THERMOPLASTIC AFOClinical Indications:• Foot drop• Weak or absent plantar flexors
and/or dorsiflexors• Severe degenerative arthritis• Severe pronation or pes planus• Lateral and medial instability
of subtalar joint• Trauma
Suggested L Codes: L1960
THERMOPLASTIC AFO - ARTICULATEDClinical Indications:• Mild Posterior Tibial Tendon
Dysfunction (PTTD)• Mild degenerative arthritis• Lateral and medial instability
of subtalar joint• Foot drop• Severe pronation• Trauma Suggested L Codes: L1970
SUPRA MALLEOLAR ORTHOSIS - SMOClinical Indications:• Arthritic conditions• Charcot foot• Chronic ankle sprains• Instability• Posterior tibial weakness or rupture• Low tone, hypotonic patient
Suggested L Code: L1907
AZ CROW WALKERTM
Clinical Indications:
• Charcot foot
Suggested L Code: L4631
Sand Black White Brown Pink Sand Black White Brown Pink
Sand Black White Brown Pink
Sand Black White Brown Pink Sand Black White Brown Pink
Sand Black White Brown Pink
Sand Black
Sand Black White Brown PinkSand Black
Sand Black White Brown
Sand Black White Brown Pink
Sand Black White Brown Pink
Sand Black White Brown Pink
Sand Black White Brown
Sand Black White Brown
Black
Black Black WhiteBlack White
Black White
Black Natural
SPECIALITY COLLECTIONTHERM
OPLASTIC COLLECTIONGAUNTLET AFO COLLECTION
TM
www.arizonaafo.comT: 877.780.8382 F: 480.222.1599
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