| HCPCS Code: |
L4396 |
| Long Description: |
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 |
| Short Description: |
Static or dynami afo pre cst |
| Pricing Indicator 1: |
38 (Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)) |
| Multiple Pricing Code: |
A (Not applicable as HCPCS priced under one methodology) |
| Statute Number: |
|
| Coverage Code: |
C (Carrier judgment) |
| ASC Payment Group Code: |
|
| Processing Note Number: |
|
| Berenson-Eggers Type of Service (BETOS) Code: |
D1F (Orthotic devices) |
| Type of Service Code 1: |
P (Lump sum purchase of DME, prosthetics, orthotics) |
| Anesthesia Base Unit Quality: |
0 |
| Code Added: |
01-01-1997 |
| Action Effective Date: |
01-01-2014 |
| Action Code: |
C (Change in long description of procedure or modifier code) |
