Local Coverage Article

Knee Orthoses - Policy Article

A52465

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Article ID
A52465
Original ICD-9 Article ID
A47270
A46762
A47178
A47174
Article Title
Knee Orthoses - Policy Article
Article Type
Article
Original Effective Date
10/01/2015
Revision Effective Date
02/01/2021
Revision Ending Date
N/A
Retirement Date
N/A
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Article Guidance

Article Text

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

For any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and 3) meet all other applicable Medicare statutory and regulatory requirements. Information provided in this policy article relates to determinations other than those based on Social Security Act §1862(a)(1)(A) provisions (i.e. “reasonable and necessary”).

For a beneficiary’s equipment to be eligible for reimbursement the reasonable and necessary (R&N) requirements set out in the related Local Coverage Determination (LCD) must be met. In addition, there are specific statutory payment policy requirements, discussed below, that also must be met.

Knee Orthoses are covered under the Medicare Braces Benefit (Social Security Act §1861(s)(9)). For coverage under this benefit, the orthosis must be a rigid or semi-rigid device, which is used for the purpose of supporting a weak or deformed body member or restricting or eliminating motion in a diseased or injured part of the body. Items that are not sufficiently rigid to be capable of providing the necessary immobilization or support to the body part for which it is designed do not meet the statutory definition of the Braces Benefit. Items that do not meet the definition of a brace are statutorily noncovered, no benefit.

Elastic or other fabric support garments (A4467 (BELT, STRAP, SLEEVE, GARMENT, OR COVERING, ANYTYPE)) with or without stays or panels do not meet the statutory definition of a brace because they are not rigid or semi-rigid devices. Code A4467 is denied as noncovered (no Medicare benefit). Refer to the coding guideline below for additional information.

Both “off-the-shelf” (OTS) and custom-fit items are considered prefabricated braces for Medicare coding purposes. 42 CFR §414.402 establishes that correct coding of knee orthoses items is dependent upon whether there is a need for “minimal self-adjustment” during the final fitting at the time of delivery. (See definitions below.) The following denials apply to incorrectly coded items based upon this regulation:

  • Correct coding of prefabricated knee orthoses (L1810, L1812, L1820, L1830, L1831, L1832, L1833, L1836, L1843, L1845, L1847, L1848, L1850, L1851, L1852) is dependent upon whether or not there is a need for “minimal self-adjustment” at the time of fitting by the beneficiary, caretaker for the beneficiary, or supplier that does not require the services of a qualified practitioner (see definitions below).

  • Claims for custom fitted orthoses (L1810, L1832, L1843, L1845, L1847) will be denied as incorrect coding when documentation shows that only minimal self-adjustment was required at the time of fitting (see Policy Specific Documentation Requirements section below).


The following chart reflects the reasonable useful lifetime of prefabricated Knee Orthoses:

L1810 1 year
L1812 1 year
L1820 1 year
L1830 1 year
L1831 2 years
L1832 2 years
L1833 2 years
L1836 3 years
L1843 3 years
L1845 3 years
L1850 2 years
L1851 3 years
L1852 3 years


The reasonable useful lifetime of custom fabricated orthosis is 3 years.

Replacement during the “reasonable useful lifetime,” is covered if the item is lost or irreparably damaged. Replacement for other reasons, including but not limited to irreparable wear, during the period of reasonable useful lifetime is denied as noncovered. L-coded additions to knee orthoses (L2275, L2320, L2330, L2385, L2390, L2395, L2397, L2405, L2415, L2425, L2430, L2492, L2750, L2755, L2780, L2785, L2795, L2800, L2810, L2820, L2830, K0672) will be denied as noncovered when the base orthosis is noncovered.

Brace sleeves (A9270) used in conjunction with orthoses are noncovered because they are not used to support a weak or deformed body member or to restrict or eliminate motion in a diseased or injured part of the body (i.e., it does not meet the definition of a brace).

Repairs to a covered orthosis are covered when they are necessary to make the orthosis functional. The reason for the repair must be documented in the supplier’s record. If the expense for repairs exceeds the estimated expense of providing another entire orthosis, no payment will be made for the amount in excess.

There is no separate payment if CAD-CAM technology is used to fabricate an Orthosis. Reimbursement is included in the allowance of the codes for custom fabricated orthoses.

Evaluation of the beneficiary, measurement and/or casting, and fitting/adjustments of the orthosis are included in the allowance for the orthosis. There is no separate payment for these services.

Payment for knee orthoses are included in the payment to a hospital or skilled nursing facility (SNF) if:

  1. The orthosis is provided to a beneficiary prior to an inpatient hospital admission or Part A covered SNF stay; and

  2. The medical necessity for the orthosis begins during the hospital or SNF stay (e.g., after knee surgery).

A claim should not be submitted to the DME MAC in this situation.

Payment for knee orthoses are also included in the payment to a hospital or a Part A covered SNF stay if:

  1. The orthosis is provided to a beneficiary during an inpatient hospital or Part A covered SNF stay prior to the day of discharge; and

  2. The beneficiary uses the item for medically necessary inpatient treatment or rehabilitation.

A claim must not be submitted to the DME MAC in this situation.

Payment for knee orthoses delivered to a beneficiary in a hospital or a Part A covered SNF stay is eligible for coverage by the DME MAC if:

  1. The orthosis is medically necessary for a beneficiary after discharge from a hospital or Part A covered SNF stay; and

  2. The orthosis is provided to the beneficiary within two days prior to discharge to home; and

  3. The orthosis is not needed for inpatient treatment or rehabilitation, but is left in the room for the beneficiary to take home.

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217)

Final Rule 1713 (84 Fed. Reg Vol 217) requires a face-to-face encounter and a Written Order Prior to Delivery (WOPD) for specified HCPCS codes. CMS and the DME MACs provides a list of the specified codes, which is periodically updated. The link will be located here once it is available.

Claims for the specified items subject to Final Rule 1713 (84 Fed. Reg Vol 217) that do not meet the face-to-face encounter and WOPD requirements specified in the LCD- related Standard Documentation Requirements Article (A55426) will be denied as not reasonable and necessary.

If a supplier delivers an item prior to receipt of a WOPD, it will be denied as not reasonable and necessary. If the WOPD is not obtained prior to delivery, payment will not be made for that item even if a WOPD is subsequently obtained by the supplier. If a similar item is subsequently provided by an unrelated supplier who has obtained a WOPD prior to delivery, it will be eligible for coverage.


POLICY SPECIFIC DOCUMENTATION REQUIREMENTS

In addition to policy specific documentation requirements, there are general documentation requirements that are applicable to all DMEPOS policies. These general requirements are located in the DOCUMENTATION REQUIREMENTS section of the LCD.

Refer to the LCD-related Standard Documentation Requirements article, located at the bottom of this Policy Article under the Related Local Coverage Documents section for additional information regarding GENERAL DOCUMENTATION REQUIREMENTS and the POLICY SPECIFIC DOCUMENTATION REQUIREMENTS discussed below.

For prefabricated orthoses, there is no physical difference between orthoses coded as custom fitted versus those coded as off-the-shelf. The differentiating factor for proper coding (see definitions in the Coding Guidelines) is the need for “minimal self-adjustment” at the time of fitting by the beneficiary, caretaker for the beneficiary, or supplier. This minimal self-adjustment does not require the services of a certified orthotist or an individual who has specialized training. Items requiring minimal self-adjustment are coded as off-the-shelf orthoses. For example, adjustment of straps and closures, bending or trimming for final fit or comfort (not all-inclusive) fall into this category.

Fabrication of an orthosis using CAD/CAM or similar technology without the creation of a positive model with minimal self-adjustment at delivery is considered as OTS.

Items requiring more than minimal self-adjustment by a qualified practitioner are coded as custom fitted (L1810, L1832, L1843, L1845, L1847). Documentation must be sufficiently detailed to include, but is not limited to, a detailed description of the modifications necessary at the time of fitting the orthosis to the beneficiary. This information must be available upon request.

For custom fabricated orthoses (L1834, L1840, L1844, L1846, L1860), there must be detailed documentation in the treating practitioner’s records to support the medical necessity of custom fabricated rather than a prefabricated orthosis as described in the Coverage Indications, Limitations and/or Medical Necessity section of the related LCD. This information will be corroborated by the functional evaluation in the orthotist or prosthetist’s records. This information must be available upon request.

When providing these items suppliers must:

  • Provide the product that is specified by the prescribing practitioner

  • Be sure that the prescribing practitioner’s medical record justifies the need for the type of product (i.e., Prefabricated versus Custom Fabricated)

  • Only bill for the HCPCS code that accurately reflects both the type of orthosis and the appropriate level of fitting

  • Have detailed documentation in supplier's records that justifies the code selected

The beneficiary’s condition (diagnosis code) that necessitates the need for the knee orthosis must be included on the claim.

KX, GA, and GZ MODIFIERS

Suppliers must add a KX modifier to knee orthoses base and addition codes only if all of the coverage criteria in the “Coverage Indications, Limitations, and/or Medical Necessity” section of the related LCD have been met and evidence of such is retained in the supplier’s files and available to the DME MAC upon request.

If all of the criteria in the Coverage Indications, Limitations, and/or Medical Necessity section of the related LCD have not been met, the GA or GZ modifier must be added to the code. When there is an expectation of a medical necessity denial, suppliers must enter the GA modifier on the claim line if they have obtained a properly executed Advance Beneficiary Notice (ABN) or the GZ modifier if they have not obtained a valid ABN.

Claims lines billed with codes without a KX, GA or GZ modifier will be rejected as missing information.

CODING GUIDELINES:

Definitions
The terms below are used to describe the types of devices referred to in this Policy Article and the related Local Coverage Determination. For more information about the terms used, refer to the DMEPOS Quality Standards (42 CFR 424.57) and the definitions for OTS and minimal self-adjustment (42 CFR Section 414.402) and CMS Benefit Policy Manual (Internet Only Manual 100-2) Ch. 15. Brace (Orthosis, Orthotic Device).

An orthosis (brace) is a rigid or semi-rigid device which is used for the purpose of supporting a weak or deformed body member or restricting or eliminating motion in a diseased or injured part of the body. An orthosis can be classified as either prefabricated (off-the-shelf or custom fitted) or custom-fabricated. Items that are not sufficiently rigid to be capable of providing the necessary immobilization or support to the body part for which it is designed do not meet the statutory definition of the Braces Benefit.

Custom Fabricated
Custom fabricated item is one that is individually made for a specific patient. No other patient would be able to use this item. A custom fabricated item is a device which is fabricated based on clinically derived and rectified castings, tracings, measurements, and/or other images (such as X-rays) of the body part.

The fabrication may involve using calculations, templates, and components. This process requires the use of basic materials including, but not limited to, plastic, metal, leather, or cloth in the form of uncut or unshaped sheets, bars, or other basic forms and involves substantial work such as vacuum forming, cutting, bending, molding, sewing, drilling, and finishing prior to fitting on the patient.

Molded-to-Patient-Model
A particular type of custom fabricated device in which either:

  • An impression (usually by means of a plaster or fiberglass cast) of the specific body part is made directly on the patient, and this impression is then used to make a positive model of the body part from which the final product is crafted; or

  • A digital image of the patient’s body part is made using Computer-Aided Design-Computer-Aided Manufacturing (CAD-CAM) systems software. This technology includes specialized probes/digitizers and scanners that create a computerized positive model, and then direct milling equipment to carve a positive model. The device is then individually fabricated and molded over the positive model of the patient.


Positive Model of the Patient
A positive model is an exact replica of the actual body part for which the custom fabricated is being constructed. A positive model can be produced by any of these methods:

  • Molded-to-patient-model is a negative impression taken of the patient’s body member and a positive model rectification is constructed;

  • CAD-CAM system, by use of digitizers, transmits surface contour data to software that the practitioner uses to rectify or modify the model on the computer screen. The data depicting the modified shape is electronically transmitted to a commercial milling machine that carves the rectified model; or

  • Direct formed model is one in which the patient serves as the positive model. The device is constructed over the model of the patient and is then fabricated to the patient. The completed custom fabrication is checked and all necessary adjustments are made.

Fabrication of an orthosis using molding, CAD/CAM, or similar technology without the creation of a positive model is considered to be a prefabricated orthosis.

Specialized Training
Specialized training is defined as training that provides the knowledge, skills, and experience in the provision of orthotics in compliance with all applicable Federal and State licensure and regulatory requirements.

Off-the-shelf (OTS) orthotics are:

  • Items that are prefabricated.

  • They may or may not be supplied as a kit that requires some assembly. Assembly of the item and/or installation of add-on components and/or the use of some basic materials in preparation of the item does not change classification from OTS to custom fitted.

  • OTS items require minimal self-adjustment for fitting at the time of delivery for appropriate use and do not require expertise in trimming, bending, molding, assembling, or customizing to fit an individual.

  • This fitting does not require expertise of a certified orthotist or an individual who has specialized training in the provision of orthoses to fit the item to the individual beneficiary.

The term “minimal self-adjustment” is defined at 42 CFR §414.402 as an adjustment the beneficiary, caretaker for the beneficiary, or supplier of the device can perform and that does not require the services of a certified orthotist (that is, an individual who is certified by the American Board for Certification in Orthotics and Prosthetics, Inc., or by the Board for Orthotist/Prosthetist Certification) or an individual who has specialized training. For example, adjustment of straps and closures, bending or trimming for final fit or comfort (not all-inclusive) fall into this category.

Use of CAD/CAM or similar technology to create an orthosis without a positive model of the patient may be considered as OTS if the final fitting upon delivery to the patient requires minimal self-adjustment as described in this section.

Custom fitted orthotics are:

  • Devices that are prefabricated.

  • They may or may not be supplied as a kit that requires some assembly. Assembly of the item and/or installation of add-on components and/or the use of some basic materials in preparation of the item does not change classification from OTS to custom fitted.

  • Classification as custom fitted requires more than minimal self-adjustment at the time of delivery in order to provide an individualized fit, i.e., the item must be trimmed, bent, molded (with or without heat), or otherwise modified resulting in alterations beyond minimal self-adjustment.

  • This fitting at delivery does require expertise of a certified orthotist or an individual who has specialized training in the provision of orthosis to fit the item to the individual beneficiary.

More than minimal self-adjustment is defined as changes made to achieve an individualized fit of the item that requires the expertise of a certified orthotist or an individual who has specialized training in the provision of orthotics in compliance with all applicable Federal and State licensure and regulatory requirements. A certified orthotist is defined as an individual who is certified by the American Board for Certification in Orthotics and Prosthetics, Inc., or by the Board for Orthotist/Prosthetist Certification.

In most cases for prefabricated orthoses, the correct coding of the orthosis is dictated by actions that take place at the time of fitting to the beneficiary, either custom-fit (requiring expertise) or off-the-shelf (OTS) (requiring minimal self-adjustment). However, for certain types of orthoses, the HCPCS code narrative that best describes the product does not make a distinction between prefabricated orthoses that are provided as custom-fit or OTS. These code narratives are correct and must be used for Medicare billing, without regard to how the product is provided to the beneficiary at the final delivery.

There are products that may be either fit by the beneficiary or require custom fitting at the time of final delivery where there are parallel sets of HCPCS codes that describe identical types of items. The codes are only differentiated based upon the nature of the final fitting performed at the time of delivery. The alternative HCPCS code types are:

  • HCPCS codes which describe “PREFABRICATED, OFF-THE-SHELF” must be used when minimal self-adjustment is the extent of the fitting performed at delivery.

  • HCPCS codes which describe “PREFABRICATED ITEM THAT HAS BEEN TRIMMED, BENT, MOLDED, ASSEMBLED, OR OTHERWISE CUSTOMIZED TO FIT A SPECIFIC PATIENT BY AN INDIVIDUAL WITH EXPERTISE” must be used when more than minimal self-adjustment is necessary at delivery.

Elastic and Similar Stretchable Materials

For items where the HCPCS code specifies “elastic” or other similar terminology for stretchable material, use the code that is most applicable to the item. A NOC (Not Otherwise Classified) or miscellaneous HCPCS code must not be used instead of the specific code. Refer to the long code narrative and any relevant coding guideline for the criteria applicable for each HCPCS code.

For items where the HCPCS code does not specify elastic or other similar terminology for stretchable material, the following guidelines apply:

  • Items that are primarily constructed of elastic or other stretchable materials (e.g. support items made of material such as neoprene or spandex (elastane, Lycra®) (not all-inclusive)) must be coded as A4467 (BELT, STRAP, SLEEVE, GARMENT, OR COVERING, ANYTYPE).

  • Items that are primarily constructed of elastic or other stretchable materials (e.g. support items made of material such as neoprene or spandex (elastane, Lycra®]) (not all-inclusive)) that contain stays and/or panels must be coded as A4467 (BELT, STRAP, SLEEVE, GARMENT, OR COVERING, ANYTYPE).

  • Items that are primarily constructed of inelastic material (e.g., canvas, cotton or nylon (not all-inclusive)) that are incapable of providing the necessary immobilization or support to the body part for which it is designed must be coded using A4467 (BELT, STRAP, SLEEVE, GARMENT, OR COVERING, ANYTYPE).

  • Items that are primarily of constructed inelastic material (e.g., canvas, cotton or nylon (not all-inclusive)) that are incapable of providing the necessary immobilization or support to the body part for which it is designed and that have stays and/or panels capable of providing the required immobilization or support to the body part for which it is designed, must be coded using A4467 (BELT, STRAP, SLEEVE, GARMENT, OR COVERING, ANYTYPE).

  • Items that are primarily constructed of inelastic material (e.g., canvas, cotton or nylon (not all-inclusive)) capable of providing the necessary immobilization or support to the body part for which it is designed must be coded using the applicable specific HCPCS code for the type of product. A NOC (Not Otherwise Classified) or miscellaneous HCPCS code must not be used instead of the specific code. Refer to the long code narrative and any relevant coding guideline for the criteria applicable for each HCPCS code.

  • Items that are primarily of constructed inelastic material (e.g., canvas, cotton or nylon (not all-inclusive)) capable of providing the necessary immobilization or support to the body part for which it is designed and that have stays and/or panels capable of providing the required immobilization or support to the body part for which it is designed, must be coded using the applicable specific HCPCS code for the type of product. A NOC (Not Otherwise Classified) or miscellaneous HCPCS code must not be used instead of the specific code. Refer to the long code narrative and relevant coding guideline for the criteria applicable for each HCPCS code.

  • Items that are not capable of providing the necessary immobilization or support to the body part for which it is designed (regardless of materials) must be coded using A9270 (NONCOVERED ITEM OR SERVICE).

Codes L1810 and L1812 describe prefabricated knee orthoses constructed of latex, neoprene, spandex or other elastic material. There are no condylar pads. There are hinges or joints.

Code L1820 describes a prefabricated knee orthosis with hinges or joints, constructed of latex, neoprene, spandex or other elastic material. There are medial and lateral condylar pads.

Code L1830 describes a prefabricated knee orthosis immobilizer, with rigid metal or plastic stays placed laterally and posteriorly. The interface material is constructed of canvas, closed cell foam or equal. The thigh and calf cuffs are one-piece construction held in place by Velcro® straps or equal. The orthosis immobilizes the knee joint and prevents flexion or extension. There are no hinges or joints.

Codes L1831, L1847 and L1848 describe prefabricated knee orthoses with joint(s) which lock the knee into a particular position. Codes L1847 and L1848 are distinguished from L1831 by the addition of an air bladder in the space behind the knee. These orthoses are designed for beneficiaries who are nonambulatory. They are typically used to treat flexion/extension contractures of the knee.

An adjustable flexion and extension joint is one that enables the practitioner to set limits on flexion and extension but allows the beneficiary free motion of the knee within those limits. The increments of adjustability must be, at a minimum, 15 degrees. The joint may be either unicentric or polycentric.

Codes L1832 and L1833 describe prefabricated knee orthoses that have double uprights and adjustable flexion and extension joints. Medial-lateral control of the knee is accomplished by the solid metal (or similar material) structure of the double uprights. They may have condylar pads. These orthoses are designed for a beneficiary who can bear weight on the knee and is capable of ambulation. They are typically used for early rehabilitation following knee surgery.

Codes L1834 and L1836 describe rigid knee orthosis without a knee joint. Both are designed to prevent knee motion. These orthoses are designed for beneficiaries who can bear weight on the knee, are capable of ambulating, and need additional support provided through immobilization of the knee joint. Code L1834 refers to a custom fabricated knee orthotic while L1836 refers to one that is pre-fabricated.

Code L1840 describes a custom fabricated knee orthosis with knee joints designed to protect the ligaments of the knee through medial-lateral torsion, providing stability and preventing rotation.

Codes L1843, L1844 and L1851 describe prefabricated and custom fabricated (respectively) knee orthoses which are constructed of rigid thigh and calf cuffs and a single upright with an adjustable flexion and extension knee joint. It must have condylar pads. Through a series of straps/supports that cross over and around the knee joint, rotational control and varus or valgus force is exerted on the knee joint. These orthoses are designed to open the medial or lateral compartment of the knee to provide pain relief due to osteoarthritis. These orthoses are designed for beneficiaries who are fully ambulatory.

Codes L1845, L1846 and L1852 describe prefabricated and custom fabricated (respectively) knee orthoses that have double uprights, condylar pads, and an adjustable flexion and extension joint and provide both medial-lateral and rotation control. Medial-lateral control of the knee is accomplished by the solid metal (or similar material) structure of the double uprights. Rotation control is accomplished by the combination of (1) solid metal (or similar material) in the anterior or posterior portion of the thigh and calf cuffs and (2) the condylar pads. These orthoses are designed for beneficiaries who are fully ambulatory.

The only products that may be billed using codes L1845 or L1852 are those for which a written coding verification review (CVR) has been made by the Pricing, Data Analysis, and Coding (PDAC) contractor and subsequently published on the Product Classification List (PCL). Information concerning the documentation that must be submitted to the PDAC for a Coding Verification Request can be found on the PDAC web site or by contacting the PDAC. A PCL with products that have received a coding verification can be found on the PDAC web site. If a product is billed to Medicare using a HCPCS code that requires written CVR, but the product is not on the PCL for that particular HCPCS code, then the claim line will be denied as incorrect coding.

Code L1850 describes a prefabricated orthosis with double uprights and thigh and calf pads. It may or may not have joints. These orthoses are used to prevent hyperextension of the knee joint in ambulatory beneficiaries.

Code L1860 describes a custom fabricated orthosis without joints, constructed of plastic or other similar material. These orthoses are used to prevent hyperextension of the knee joint in ambulatory beneficiaries.

Code L2755 describes an addition to a lower extremity orthosis composed of high strength and/or lightweight material such as Kevlar®, carbon fiber or other laminated or impregnated composite material.

“Addition” codes are grouped into four (4) categories in relation to knee orthosis base codes.

  • Eligible for separate payment

  • Not medically necessary

  • Not separately payable

  • Incompatible

Addition codes in the first two categories are addressed in the related LCD. Addition codes that are not separately payable are addressed in the tables below.

The following table lists addition codes which describe components or features that can be physically incorporated in the specified prefabricated bases orthosis but are considered to be included in the allowance for the orthosis.

Base Code Addition Codes - Not Separately Payable
L1810 L2390, L2750, L2780, L4002
L1812 L2390, L2750, L2780, L4002
L1820 L2390, L2750, L2780, L2810, L4002
L1830 K0672, L4002
L1831 K0672, L2390, L2425, L2430, L2750, L2780, L2810, L2820, L2830, L4002
L1832 K0672, L2390, L2425, L2430, L2750, L2780, L2820, L2830, L4002
L1833 K0672, L2390, L2425, L2430, L2750, L2780, L2820, L2830, L4002
L1836 K0672, L2750, L2780, L2810, L2820, L2830, L4002
L1843 K0672, L2275, L2390, L2425, L2430, L2750, L2780, L2810, L2820, L2830, L4002
L1845 K0672, L2275, L2390, L2425, L2430, L2750, L2780, L2810, L2820, L2830, L4002
L1847 K0672, L2390, L2425, L2430, L2750, L2780, L2810, L2820, L2830, L4002
L1848 K0672, L2390, L2425, L2430, L2750, L2780, L2810, L2820, L2830, L4002
L1850 K0672, L2750, L2780, L2810, L2820, L2830, L4002
L1851 K0672, L2275, L2390, L2425, L2430, L2750, L2780, L2810, L2820, L2830, L4002
L1852 K0672, L2275, L2390, L2425, L2430, L2750, L2780, L2810, L2820, L2830, L4002

 

The following table lists addition codes which describe components or features that can be physically incorporated in the specified custom fabricated bases orthosis but that are considered to be included in the allowance for the orthosis. The addition codes will be denied as not separately payable if they are billed with the related base code.

Base Code Addition Codes - Not Separately Payable
L1834 K0672, L2820, L2830, L4002
L1840 K0672, L2320, L2330, L2750, L2780, L2810, L2820, L2830, L4002
L1844 K0672, L2275, L2320, L2330, L2425, L2430, L2750, L2780, L2810, L2820, L2830, L4002
L1846 K0672, L2275, L2320, L2330, L2425, L2430, L2750, L2780, L2810, L2820, L2830, L4002
L1860 K0672, L2820, L2830, L4002


All addition codes that are not listed as either separately payable or not medically necessary in the tables in the LCD or as not separately payable in the tables above describe components or features that either cannot be physically incorporated in the specified base orthosis or whose narrative description is incompatible with base orthosis code (e.g., billing a prefabricated base code with an addition code which specifies that is it only used with custom fabricated orthoses). These incompatible addition codes will be rejected as incorrect coding.

A replacement removable soft interface for a knee orthosis is billed with code K0672 (ADDITION TO LOWER EXTREMITY ORTHOSIS, REMOVABLE SOFT INTERFACE, ALL COMPONENTS, REPLACEMENT ONLY, EACH). One unit of service includes all the components that are used at the same time on a single orthosis.

Either a nonremovable soft interface (L2820, L2830) or two (2) removable soft interfaces (K0672) are included in the allowance for a knee orthosis. Soft interfaces billed separately at the time of initial issue will be denied as not separately payable.

Codes L2320 and L2330 (non-molded and molded lacers, respectively) may only be billed as replacement items.

All claims for devices that contain a concentric adjustable torsion style mechanism in the knee joint for any condition other than an assistive function to joint extension motion must be coded as Durable Medical Equipment using codes E1810 (dynamic adjustable knee extension/flexion device). If a concentric adjustable torsion style mechanism in the knee joint is used solely to provide an assistive function for joint extension, it must be coded as L2999 (See Coverage Indications, Limitations and/or Medical Necessity section of the related LCD).

Claims for devices that contain a concentric adjustable torsion style mechanism in the knee joint and that are being used to treat any condition other than an assistive function to joint extension motion are not covered under the Braces benefit and will be denied as incorrect coding when billed using code L2999 (See Coverage Indications, Limitations and/or Medical Necessity section of the related LCD).

The allowance for the labor involved in replacing/repairing an orthotic component that is coded with a specific L code is included in the allowance for that component. The allowance for the labor (L4205) involved in replacing/repairing an orthotic component that is coded with the miscellaneous code L4210 is separately payable in addition to the allowance for that component.

Code L4002 is for billing of replacement component(s) and is not payable at initial issue of a base orthosis. When code L4002 is billed at the time of initial issue of a base orthosis, it will be denied as not separately payable.

The right (RT) and/or left (LT) modifiers must be used when billing for orthosis base codes, additions and replacement parts. Effective for claims with dates of service (DOS) on or after 3/1/2019, when the same code for bilateral items (left and right) is billed on the same date of service, bill each item on two separate claim lines using the RT and LT modifiers and 1 unit of service (UOS) on each claim line. Do not use the RTLT modifier on the same claim line and billed with 2 UOS. Claims billed without modifiers RT and/or LT, or with RTLT on the same claim line and 2 UOS, will be rejected as incorrect coding.

Code L2999 (lower extremity orthosis, not otherwise specified) should be used only when billing for item(s) that do not meet the definition of an existing code(s).

Code L4205 (Repair of orthotic device, labor component, per 15 minutes) may only be billed for time involved with the actual repair of an orthosis or for medically necessary adjustments made more than 90 days after delivery. Code L4205 must not be used to bill for time involved with other professional services including, but not limited to:

  • Evaluating the beneficiary

  • Taking measurements, making a cast, making a model, use of CAD/CAM

  • Making modifications to a prefabricated item to fit it to the individual beneficiary

  • Follow-up visits

  • Making adjustments at the time of or within 90 days after delivery

Suppliers must distinguish between repair and replacement of an orthosis. When an orthotic is replaced, there is no separate billing for the above services because reimbursement for these services is included in the allowance for the replacement item.

Repairs to a covered orthosis due to wear or to accidental damage are covered when they are necessary to make the orthosis functional. The reason for the repair must be documented in the supplier's record. If the expense for repairs exceeds the estimated expense of providing another entire orthosis, no payment will be made for the amount in excess.

Similarly, code L4210 (Repair of orthotic device, repair or replace minor parts) must not be used for casting supplies or other materials used in the fitting or fabrication of an orthosis.

Should a supplier wish to submit a claim for services/items that are included in the allowance for the orthosis, code L9900 (Orthotic and prosthetic supply, accessory and/or service component of another HCPCS L code) must be used. Code L9900 is denied as not separately payable.

Suppliers should contact the PDAC contractor for guidance on the correct coding of these items.

Coding Information

CPT/HCPCS Codes

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 1 Paragraph

The presence of an ICD-10 code listed in this section is not sufficient by itself to assure coverage. Refer to the LCD section on “Coverage Indications, Limitations, and/or Medical Necessity” for other coverage criteria and payment information.

For HCPCS codes L1831 and L1836:

Group 1 Codes
CodeDescription
M24.561 Contracture, right knee
M24.562 Contracture, left knee

Group 2

Group 2 Paragraph

For HCPCS Codes L1830, L1832, L1833, and L1834:

Group 2 Codes
CodeDescription
M05.061 Felty's syndrome, right knee
M05.062 Felty's syndrome, left knee
M05.261 Rheumatoid vasculitis with rheumatoid arthritis of right knee
M05.262 Rheumatoid vasculitis with rheumatoid arthritis of left knee
M05.361 Rheumatoid heart disease with rheumatoid arthritis of right knee
M05.362 Rheumatoid heart disease with rheumatoid arthritis of left knee
M05.461 Rheumatoid myopathy with rheumatoid arthritis of right knee
M05.462 Rheumatoid myopathy with rheumatoid arthritis of left knee
M05.561 Rheumatoid polyneuropathy with rheumatoid arthritis of right knee
M05.562 Rheumatoid polyneuropathy with rheumatoid arthritis of left knee
M05.661 Rheumatoid arthritis of right knee with involvement of other organs and systems
M05.662 Rheumatoid arthritis of left knee with involvement of other organs and systems
M05.761 Rheumatoid arthritis with rheumatoid factor of right knee without organ or systems involvement
M05.762 Rheumatoid arthritis with rheumatoid factor of left knee without organ or systems involvement
M05.861 Other rheumatoid arthritis with rheumatoid factor of right knee
M05.862 Other rheumatoid arthritis with rheumatoid factor of left knee
M06.061 Rheumatoid arthritis without rheumatoid factor, right knee
M06.062 Rheumatoid arthritis without rheumatoid factor, left knee
M06.1 Adult-onset Still's disease
M06.261 Rheumatoid bursitis, right knee
M06.262 Rheumatoid bursitis, left knee
M06.361 Rheumatoid nodule, right knee
M06.362 Rheumatoid nodule, left knee
M06.861 Other specified rheumatoid arthritis, right knee
M06.862 Other specified rheumatoid arthritis, left knee
M08.061 Unspecified juvenile rheumatoid arthritis, right knee
M08.062 Unspecified juvenile rheumatoid arthritis, left knee
M08.261 Juvenile rheumatoid arthritis with systemic onset, right knee
M08.262 Juvenile rheumatoid arthritis with systemic onset, left knee
M08.3 Juvenile rheumatoid polyarthritis (seronegative)
M08.461 Pauciarticular juvenile rheumatoid arthritis, right knee
M08.462 Pauciarticular juvenile rheumatoid arthritis, left knee
M08.861 Other juvenile arthritis, right knee
M08.862 Other juvenile arthritis, left knee
M08.961 Juvenile arthritis, unspecified, right knee
M08.962 Juvenile arthritis, unspecified, left knee
M12.061 Chronic postrheumatic arthropathy [Jaccoud], right knee
M12.062 Chronic postrheumatic arthropathy [Jaccoud], left knee
M17.0 Bilateral primary osteoarthritis of knee
M17.11 Unilateral primary osteoarthritis, right knee
M17.12 Unilateral primary osteoarthritis, left knee
M17.2 Bilateral post-traumatic osteoarthritis of knee
M17.31 Unilateral post-traumatic osteoarthritis, right knee
M17.32 Unilateral post-traumatic osteoarthritis, left knee
M17.4 Other bilateral secondary osteoarthritis of knee
M17.5 Other unilateral secondary osteoarthritis of knee
M17.9 Osteoarthritis of knee, unspecified
M22.2X1 Patellofemoral disorders, right knee
M22.2X2 Patellofemoral disorders, left knee
M22.3X1 Other derangements of patella, right knee
M22.3X2 Other derangements of patella, left knee
M22.41 Chondromalacia patellae, right knee
M22.42 Chondromalacia patellae, left knee
M22.8X1 Other disorders of patella, right knee
M22.8X2 Other disorders of patella, left knee
M22.91 Unspecified disorder of patella, right knee
M22.92 Unspecified disorder of patella, left knee
M23.000 Cystic meniscus, unspecified lateral meniscus, right knee
M23.001 Cystic meniscus, unspecified lateral meniscus, left knee
M23.003 Cystic meniscus, unspecified medial meniscus, right knee
M23.004 Cystic meniscus, unspecified medial meniscus, left knee
M23.006 Cystic meniscus, unspecified meniscus, right knee
M23.007 Cystic meniscus, unspecified meniscus, left knee
M23.011 Cystic meniscus, anterior horn of medial meniscus, right knee
M23.012 Cystic meniscus, anterior horn of medial meniscus, left knee
M23.021 Cystic meniscus, posterior horn of medial meniscus, right knee
M23.022 Cystic meniscus, posterior horn of medial meniscus, left knee
M23.031 Cystic meniscus, other medial meniscus, right knee
M23.032 Cystic meniscus, other medial meniscus, left knee
M23.041 Cystic meniscus, anterior horn of lateral meniscus, right knee
M23.042 Cystic meniscus, anterior horn of lateral meniscus, left knee
M23.051 Cystic meniscus, posterior horn of lateral meniscus, right knee
M23.052 Cystic meniscus, posterior horn of lateral meniscus, left knee
M23.061 Cystic meniscus, other lateral meniscus, right knee
M23.062 Cystic meniscus, other lateral meniscus, left knee
M23.200 Derangement of unspecified lateral meniscus due to old tear or injury, right knee
M23.201 Derangement of unspecified lateral meniscus due to old tear or injury, left knee
M23.203 Derangement of unspecified medial meniscus due to old tear or injury, right knee
M23.204 Derangement of unspecified medial meniscus due to old tear or injury, left knee
M23.206 Derangement of unspecified meniscus due to old tear or injury, right knee
M23.207 Derangement of unspecified meniscus due to old tear or injury, left knee
M23.211 Derangement of anterior horn of medial meniscus due to old tear or injury, right knee
M23.212 Derangement of anterior horn of medial meniscus due to old tear or injury, left knee
M23.221 Derangement of posterior horn of medial meniscus due to old tear or injury, right knee
M23.222 Derangement of posterior horn of medial meniscus due to old tear or injury, left knee
M23.231 Derangement of other medial meniscus due to old tear or injury, right knee
M23.232 Derangement of other medial meniscus due to old tear or injury, left knee
M23.241 Derangement of anterior horn of lateral meniscus due to old tear or injury, right knee
M23.242 Derangement of anterior horn of lateral meniscus due to old tear or injury, left knee
M23.251 Derangement of posterior horn of lateral meniscus due to old tear or injury, right knee
M23.252 Derangement of posterior horn of lateral meniscus due to old tear or injury, left knee
M23.261 Derangement of other lateral meniscus due to old tear or injury, right knee
M23.262 Derangement of other lateral meniscus due to old tear or injury, left knee
M23.300 Other meniscus derangements, unspecified lateral meniscus, right knee
M23.301 Other meniscus derangements, unspecified lateral meniscus, left knee
M23.303 Other meniscus derangements, unspecified medial meniscus, right knee
M23.304 Other meniscus derangements, unspecified medial meniscus, left knee
M23.306 Other meniscus derangements, unspecified meniscus, right knee
M23.307 Other meniscus derangements, unspecified meniscus, left knee
M23.311 Other meniscus derangements, anterior horn of medial meniscus, right knee
M23.312 Other meniscus derangements, anterior horn of medial meniscus, left knee
M23.321 Other meniscus derangements, posterior horn of medial meniscus, right knee
M23.322 Other meniscus derangements, posterior horn of medial meniscus, left knee
M23.331 Other meniscus derangements, other medial meniscus, right knee
M23.332 Other meniscus derangements, other medial meniscus, left knee
M23.341 Other meniscus derangements, anterior horn of lateral meniscus, right knee
M23.342 Other meniscus derangements, anterior horn of lateral meniscus, left knee
M23.351 Other meniscus derangements, posterior horn of lateral meniscus, right knee
M23.352 Other meniscus derangements, posterior horn of lateral meniscus, left knee
M23.361 Other meniscus derangements, other lateral meniscus, right knee
M23.362 Other meniscus derangements, other lateral meniscus, left knee
M23.51 Chronic instability of knee, right knee
M23.52 Chronic instability of knee, left knee
M23.601 Other spontaneous disruption of unspecified ligament of right knee
M23.602 Other spontaneous disruption of unspecified ligament of left knee
M23.611 Other spontaneous disruption of anterior cruciate ligament of right knee
M23.612 Other spontaneous disruption of anterior cruciate ligament of left knee
M23.621 Other spontaneous disruption of posterior cruciate ligament of right knee
M23.622 Other spontaneous disruption of posterior cruciate ligament of left knee
M23.631 Other spontaneous disruption of medial collateral ligament of right knee
M23.632 Other spontaneous disruption of medial collateral ligament of left knee
M23.641 Other spontaneous disruption of lateral collateral ligament of right knee
M23.642 Other spontaneous disruption of lateral collateral ligament of left knee
M23.671 Other spontaneous disruption of capsular ligament of right knee
M23.672 Other spontaneous disruption of capsular ligament of left knee
M23.8X1 Other internal derangements of right knee
M23.8X2 Other internal derangements of left knee
M23.91 Unspecified internal derangement of right knee
M23.92 Unspecified internal derangement of left knee
M66.251 Spontaneous rupture of extensor tendons, right thigh
M66.252 Spontaneous rupture of extensor tendons, left thigh
M66.261 Spontaneous rupture of extensor tendons, right lower leg
M66.262 Spontaneous rupture of extensor tendons, left lower leg
M80.051A - M80.052S Age-related osteoporosis with current pathological fracture, right femur, initial encounter for fracture - Age-related osteoporosis with current pathological fracture, left femur, sequela
M80.061A - M80.062S Age-related osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture - Age-related osteoporosis with current pathological fracture, left lower leg, sequela
M80.851A - M80.852S Other osteoporosis with current pathological fracture, right femur, initial encounter for fracture - Other osteoporosis with current pathological fracture, left femur, sequela
M80.861A - M80.862S Other osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture - Other osteoporosis with current pathological fracture, left lower leg, sequela
M84.351A - M84.352S Stress fracture, right femur, initial encounter for fracture - Stress fracture, left femur, sequela
M84.361A - M84.364S Stress fracture, right tibia, initial encounter for fracture - Stress fracture, left fibula, sequela
M84.451A - M84.452S Pathological fracture, right femur, initial encounter for fracture - Pathological fracture, left femur, sequela
M84.461A - M84.464S Pathological fracture, right tibia, initial encounter for fracture - Pathological fracture, left fibula, sequela
M84.551A - M84.552S Pathological fracture in neoplastic disease, right femur, initial encounter for fracture - Pathological fracture in neoplastic disease, left femur, sequela
M84.561A - M84.564S Pathological fracture in neoplastic disease, right tibia, initial encounter for fracture - Pathological fracture in neoplastic disease, left fibula, sequela
M84.651A - M84.652S Pathological fracture in other disease, right femur, initial encounter for fracture - Pathological fracture in other disease, left femur, sequela
M84.661A - M84.664S Pathological fracture in other disease, right tibia, initial encounter for fracture - Pathological fracture in other disease, left fibula, sequela
M87.061 Idiopathic aseptic necrosis of right tibia
M87.062 Idiopathic aseptic necrosis of left tibia
M87.064 Idiopathic aseptic necrosis of right fibula
M87.065 Idiopathic aseptic necrosis of left fibula
M87.161 Osteonecrosis due to drugs, right tibia
M87.162 Osteonecrosis due to drugs, left tibia
M87.164 Osteonecrosis due to drugs, right fibula
M87.165 Osteonecrosis due to drugs, left fibula
M87.261 Osteonecrosis due to previous trauma, right tibia
M87.262 Osteonecrosis due to previous trauma, left tibia
M87.264 Osteonecrosis due to previous trauma, right fibula
M87.265 Osteonecrosis due to previous trauma, left fibula
M87.361 Other secondary osteonecrosis, right tibia
M87.362 Other secondary osteonecrosis, left tibia
M87.364 Other secondary osteonecrosis, right fibula
M87.365 Other secondary osteonecrosis, left fibula
M87.861 Other osteonecrosis, right tibia
M87.862 Other osteonecrosis, left tibia
M87.864 Other osteonecrosis, right fibula
M87.865 Other osteonecrosis, left fibula
M90.561 Osteonecrosis in diseases classified elsewhere, right lower leg
M90.562 Osteonecrosis in diseases classified elsewhere, left lower leg
M96.661 Fracture of femur following insertion of orthopedic implant, joint prosthesis, or bone plate, right leg
M96.662 Fracture of femur following insertion of orthopedic implant, joint prosthesis, or bone plate, left leg
M96.671 Fracture of tibia or fibula following insertion of orthopedic implant, joint prosthesis, or bone plate, right leg
M96.672 Fracture of tibia or fibula following insertion of orthopedic implant, joint prosthesis, or bone plate, left leg
Q68.2 Congenital deformity of knee
Q68.6 Discoid meniscus
Q74.1 Congenital malformation of knee
S72.001A - S72.002S Fracture of unspecified part of neck of right femur, initial encounter for closed fracture - Fracture of unspecified part of neck of left femur, sequela
S72.011A - S72.012S Unspecified intracapsular fracture of right femur, initial encounter for closed fracture - Unspecified intracapsular fracture of left femur, sequela
S72.021A - S72.022S Displaced fracture of epiphysis (separation) (upper) of right femur, initial encounter for closed fracture - Displaced fracture of epiphysis (separation) (upper) of left femur, sequela
S72.024A - S72.025S Nondisplaced fracture of epiphysis (separation) (upper) of right femur, initial encounter for closed fracture - Nondisplaced fracture of epiphysis (separation) (upper) of left femur, sequela
S72.031A - S72.032S Displaced midcervical fracture of right femur, initial encounter for closed fracture - Displaced midcervical fracture of left femur, sequela
S72.034A - S72.035S Nondisplaced midcervical fracture of right femur, initial encounter for closed fracture - Nondisplaced midcervical fracture of left femur, sequela
S72.041A - S72.042S Displaced fracture of base of neck of right femur, initial encounter for closed fracture - Displaced fracture of base of neck of left femur, sequela
S72.044A - S72.045S Nondisplaced fracture of base of neck of right femur, initial encounter for closed fracture - Nondisplaced fracture of base of neck of left femur, sequela
S72.051A - S72.052S Unspecified fracture of head of right femur, initial encounter for closed fracture - Unspecified fracture of head of left femur, sequela
S72.061A - S72.062S Displaced articular fracture of head of right femur, initial encounter for closed fracture - Displaced articular fracture of head of left femur, sequela
S72.064A - S72.065S Nondisplaced articular fracture of head of right femur, initial encounter for closed fracture - Nondisplaced articular fracture of head of left femur, sequela
S72.091A - S72.092S Other fracture of head and neck of right femur, initial encounter for closed fracture - Other fracture of head and neck of left femur, sequela
S72.101A - S72.102S Unspecified trochanteric fracture of right femur, initial encounter for closed fracture - Unspecified trochanteric fracture of left femur, sequela
S72.111A - S72.112S Displaced fracture of greater trochanter of right femur, initial encounter for closed fracture - Displaced fracture of greater trochanter of left femur, sequela
S72.114A - S72.115S Nondisplaced fracture of greater trochanter of right femur, initial encounter for closed fracture - Nondisplaced fracture of greater trochanter of left femur, sequela
S72.121A - S72.122S Displaced fracture of lesser trochanter of right femur, initial encounter for closed fracture - Displaced fracture of lesser trochanter of left femur, sequela
S72.124A - S72.125S Nondisplaced fracture of lesser trochanter of right femur, initial encounter for closed fracture - Nondisplaced fracture of lesser trochanter of left femur, sequela
S72.131A - S72.132S Displaced apophyseal fracture of right femur, initial encounter for closed fracture - Displaced apophyseal fracture of left femur, sequela
S72.134A - S72.135S Nondisplaced apophyseal fracture of right femur, initial encounter for closed fracture - Nondisplaced apophyseal fracture of left femur, sequela
S72.141A - S72.142S Displaced intertrochanteric fracture of right femur, initial encounter for closed fracture - Displaced intertrochanteric fracture of left femur, sequela
S72.144A - S72.145S Nondisplaced intertrochanteric fracture of right femur, initial encounter for closed fracture - Nondisplaced intertrochanteric fracture of left femur, sequela
S72.21XA - S72.22XS Displaced subtrochanteric fracture of right femur, initial encounter for closed fracture - Displaced subtrochanteric fracture of left femur, sequela
S72.24XA - S72.25XS Nondisplaced subtrochanteric fracture of right femur, initial encounter for closed fracture - Nondisplaced subtrochanteric fracture of left femur, sequela
S72.301A - S72.302S Unspecified fracture of shaft of right femur, initial encounter for closed fracture - Unspecified fracture of shaft of left femur, sequela
S72.321A - S72.322S Displaced transverse fracture of shaft of right femur, initial encounter for closed fracture - Displaced transverse fracture of shaft of left femur, sequela
S72.324A - S72.325S Nondisplaced transverse fracture of shaft of right femur, initial encounter for closed fracture - Nondisplaced transverse fracture of shaft of left femur, sequela
S72.331A - S72.332S Displaced oblique fracture of shaft of right femur, initial encounter for closed fracture - Displaced oblique fracture of shaft of left femur, sequela
S72.334A - S72.335S Nondisplaced oblique fracture of shaft of right femur, initial encounter for closed fracture - Nondisplaced oblique fracture of shaft of left femur, sequela
S72.341A - S72.342S Displaced spiral fracture of shaft of right femur, initial encounter for closed fracture - Displaced spiral fracture of shaft of left femur, sequela
S72.344A - S72.345S Nondisplaced spiral fracture of shaft of right femur, initial encounter for closed fracture - Nondisplaced spiral fracture of shaft of left femur, sequela
S72.351A - S72.352S Displaced comminuted fracture of shaft of right femur, initial encounter for closed fracture - Displaced comminuted fracture of shaft of left femur, sequela
S72.354A - S72.355S Nondisplaced comminuted fracture of shaft of right femur, initial encounter for closed fracture - Nondisplaced comminuted fracture of shaft of left femur, sequela
S72.361A - S72.362S Displaced segmental fracture of shaft of right femur, initial encounter for closed fracture - Displaced segmental fracture of shaft of left femur, sequela
S72.364A - S72.365S Nondisplaced segmental fracture of shaft of right femur, initial encounter for closed fracture - Nondisplaced segmental fracture of shaft of left femur, sequela
S72.391A - S72.392S Other fracture of shaft of right femur, initial encounter for closed fracture - Other fracture of shaft of left femur, sequela
S72.401A - S72.402S Unspecified fracture of lower end of right femur, initial encounter for closed fracture - Unspecified fracture of lower end of left femur, sequela
S72.411A - S72.412S Displaced unspecified condyle fracture of lower end of right femur, initial encounter for closed fracture - Displaced unspecified condyle fracture of lower end of left femur, sequela
S72.414A - S72.415S Nondisplaced unspecified condyle fracture of lower end of right femur, initial encounter for closed fracture - Nondisplaced unspecified condyle fracture of lower end of left femur, sequela
S72.421A - S72.422S Displaced fracture of lateral condyle of right femur, initial encounter for closed fracture - Displaced fracture of lateral condyle of left femur, sequela
S72.424A - S72.425S Nondisplaced fracture of lateral condyle of right femur, initial encounter for closed fracture - Nondisplaced fracture of lateral condyle of left femur, sequela
S72.431A - S72.432S Displaced fracture of medial condyle of right femur, initial encounter for closed fracture - Displaced fracture of medial condyle of left femur, sequela
S72.434A - S72.435S Nondisplaced fracture of medial condyle of right femur, initial encounter for closed fracture - Nondisplaced fracture of medial condyle of left femur, sequela
S72.441A - S72.442S Displaced fracture of lower epiphysis (separation) of right femur, initial encounter for closed fracture - Displaced fracture of lower epiphysis (separation) of left femur, sequela
S72.444A - S72.445S Nondisplaced fracture of lower epiphysis (separation) of right femur, initial encounter for closed fracture - Nondisplaced fracture of lower epiphysis (separation) of left femur, sequela
S72.451A - S72.452S Displaced supracondylar fracture without intracondylar extension of lower end of right femur, initial encounter for closed fracture - Displaced supracondylar fracture without intracondylar extension of lower end of left femur, sequela
S72.454A - S72.455S Nondisplaced supracondylar fracture without intracondylar extension of lower end of right femur, initial encounter for closed fracture - Nondisplaced supracondylar fracture without intracondylar extension of lower end of left femur, sequela
S72.461A - S72.462S Displaced supracondylar fracture with intracondylar extension of lower end of right femur, initial encounter for closed fracture - Displaced supracondylar fracture with intracondylar extension of lower end of left femur, sequela
S72.464A - S72.465S Nondisplaced supracondylar fracture with intracondylar extension of lower end of right femur, initial encounter for closed fracture - Nondisplaced supracondylar fracture with intracondylar extension of lower end of left femur, sequela
S72.471A - S72.472S Torus fracture of lower end of right femur, initial encounter for closed fracture - Torus fracture of lower end of left femur, sequela
S72.491A - S72.492S Other fracture of lower end of right femur, initial encounter for closed fracture - Other fracture of lower end of left femur, sequela
S72.8X1A - S72.8X2S Other fracture of right femur, initial encounter for closed fracture - Other fracture of left femur, sequela
S72.91XA - S72.92XS Unspecified fracture of right femur, initial encounter for closed fracture - Unspecified fracture of left femur, sequela
S76.111A Strain of right quadriceps muscle, fascia and tendon, initial encounter
S76.111D Strain of right quadriceps muscle, fascia and tendon, subsequent encounter
S76.111S Strain of right quadriceps muscle, fascia and tendon, sequela
S76.112A Strain of left quadriceps muscle, fascia and tendon, initial encounter
S76.112D Strain of left quadriceps muscle, fascia and tendon, subsequent encounter
S76.112S Strain of left quadriceps muscle, fascia and tendon, sequela
S76.121A Laceration of right quadriceps muscle, fascia and tendon, initial encounter
S76.121D Laceration of right quadriceps muscle, fascia and tendon, subsequent encounter
S76.121S Laceration of right quadriceps muscle, fascia and tendon, sequela
S76.122A Laceration of left quadriceps muscle, fascia and tendon, initial encounter
S76.122D Laceration of left quadriceps muscle, fascia and tendon, subsequent encounter
S76.122S Laceration of left quadriceps muscle, fascia and tendon, sequela
S79.001A - S79.002S Unspecified physeal fracture of upper end of right femur, initial encounter for closed fracture - Unspecified physeal fracture of upper end of left femur, sequela
S79.011A - S79.012S Salter-Harris Type I physeal fracture of upper end of right femur, initial encounter for closed fracture - Salter-Harris Type I physeal fracture of upper end of left femur, sequela
S79.091A - S79.092S Other physeal fracture of upper end of right femur, initial encounter for closed fracture - Other physeal fracture of upper end of left femur, sequela
S79.101A - S79.102S Unspecified physeal fracture of lower end of right femur, initial encounter for closed fracture - Unspecified physeal fracture of lower end of left femur, sequela
S79.111A - S79.112S Salter-Harris Type I physeal fracture of lower end of right femur, initial encounter for closed fracture - Salter-Harris Type I physeal fracture of lower end of left femur, sequela
S79.121A - S79.122S Salter-Harris Type II physeal fracture of lower end of right femur, initial encounter for closed fracture - Salter-Harris Type II physeal fracture of lower end of left femur, sequela
S79.131A - S79.132S Salter-Harris Type III physeal fracture of lower end of right femur, initial encounter for closed fracture - Salter-Harris Type III physeal fracture of lower end of left femur, sequela
S79.141A - S79.142S Salter-Harris Type IV physeal fracture of lower end of right femur, initial encounter for closed fracture - Salter-Harris Type IV physeal fracture of lower end of left femur, sequela
S79.191A - S79.192S Other physeal fracture of lower end of right femur, initial encounter for closed fracture - Other physeal fracture of lower end of left femur, sequela
S82.001A - S82.002S Unspecified fracture of right patella, initial encounter for closed fracture - Unspecified fracture of left patella, sequela
S82.011A - S82.012S Displaced osteochondral fracture of right patella, initial encounter for closed fracture - Displaced osteochondral fracture of left patella, sequela
S82.014A - S82.015S Nondisplaced osteochondral fracture of right patella, initial encounter for closed fracture - Nondisplaced osteochondral fracture of left patella, sequela
S82.021A - S82.022S Displaced longitudinal fracture of right patella, initial encounter for closed fracture - Displaced longitudinal fracture of left patella, sequela
S82.024A - S82.025S Nondisplaced longitudinal fracture of right patella, initial encounter for closed fracture - Nondisplaced longitudinal fracture of left patella, sequela
S82.031A - S82.032S Displaced transverse fracture of right patella, initial encounter for closed fracture - Displaced transverse fracture of left patella, sequela
S82.034A - S82.035S Nondisplaced transverse fracture of right patella, initial encounter for closed fracture - Nondisplaced transverse fracture of left patella, sequela
S82.041A - S82.042S Displaced comminuted fracture of right patella, initial encounter for closed fracture - Displaced comminuted fracture of left patella, sequela
S82.044A - S82.045S Nondisplaced comminuted fracture of right patella, initial encounter for closed fracture - Nondisplaced comminuted fracture of left patella, sequela
S82.091A - S82.092S Other fracture of right patella, initial encounter for closed fracture - Other fracture of left patella, sequela
S82.101A - S82.102S Unspecified fracture of upper end of right tibia, initial encounter for closed fracture - Unspecified fracture of upper end of left tibia, sequela
S82.111A - S82.112S Displaced fracture of right tibial spine, initial encounter for closed fracture - Displaced fracture of left tibial spine, sequela
S82.114A - S82.115S Nondisplaced fracture of right tibial spine, initial encounter for closed fracture - Nondisplaced fracture of left tibial spine, sequela
S82.121A - S82.122S Displaced fracture of lateral condyle of right tibia, initial encounter for closed fracture - Displaced fracture of lateral condyle of left tibia, sequela
S82.124A - S82.125S Nondisplaced fracture of lateral condyle of right tibia, initial encounter for closed fracture - Nondisplaced fracture of lateral condyle of left tibia, sequela
S82.131A - S82.132S Displaced fracture of medial condyle of right tibia, initial encounter for closed fracture - Displaced fracture of medial condyle of left tibia, sequela
S82.134A - S82.135S Nondisplaced fracture of medial condyle of right tibia, initial encounter for closed fracture - Nondisplaced fracture of medial condyle of left tibia, sequela
S82.141A - S82.142S Displaced bicondylar fracture of right tibia, initial encounter for closed fracture - Displaced bicondylar fracture of left tibia, sequela
S82.144A - S82.145S Nondisplaced bicondylar fracture of right tibia, initial encounter for closed fracture - Nondisplaced bicondylar fracture of left tibia, sequela
S82.151A - S82.152S Displaced fracture of right tibial tuberosity, initial encounter for closed fracture - Displaced fracture of left tibial tuberosity, sequela
S82.154A - S82.155S Nondisplaced fracture of right tibial tuberosity, initial encounter for closed fracture - Nondisplaced fracture of left tibial tuberosity, sequela
S82.161A - S82.162S Torus fracture of upper end of right tibia, initial encounter for closed fracture - Torus fracture of upper end of left tibia, sequela
S82.191A - S82.192S Other fracture of upper end of right tibia, initial encounter for closed fracture - Other fracture of upper end of left tibia, sequela
S82.201A - S82.202S Unspecified fracture of shaft of right tibia, initial encounter for closed fracture - Unspecified fracture of shaft of left tibia, sequela
S82.221A - S82.222S Displaced transverse fracture of shaft of right tibia, initial encounter for closed fracture - Displaced transverse fracture of shaft of left tibia, sequela
S82.224A - S82.225S Nondisplaced transverse fracture of shaft of right tibia, initial encounter for closed fracture - Nondisplaced transverse fracture of shaft of left tibia, sequela
S82.231A - S82.232S Displaced oblique fracture of shaft of right tibia, initial encounter for closed fracture - Displaced oblique fracture of shaft of left tibia, sequela
S82.234A - S82.235S Nondisplaced oblique fracture of shaft of right tibia, initial encounter for closed fracture - Nondisplaced oblique fracture of shaft of left tibia, sequela
S82.241A - S82.242S Displaced spiral fracture of shaft of right tibia, initial encounter for closed fracture - Displaced spiral fracture of shaft of left tibia, sequela
S82.244A - S82.245S Nondisplaced spiral fracture of shaft of right tibia, initial encounter for closed fracture - Nondisplaced spiral fracture of shaft of left tibia, sequela
S82.251A - S82.252S Displaced comminuted fracture of shaft of right tibia, initial encounter for closed fracture - Displaced comminuted fracture of shaft of left tibia, sequela
S82.254A - S82.255S Nondisplaced comminuted fracture of shaft of right tibia, initial encounter for closed fracture - Nondisplaced comminuted fracture of shaft of left tibia, sequela
S82.261A - S82.262S Displaced segmental fracture of shaft of right tibia, initial encounter for closed fracture - Displaced segmental fracture of shaft of left tibia, sequela
S82.264A - S82.265S Nondisplaced segmental fracture of shaft of right tibia, initial encounter for closed fracture - Nondisplaced segmental fracture of shaft of left tibia, sequela
S82.291A - S82.292S Other fracture of shaft of right tibia, initial encounter for closed fracture - Other fracture of shaft of left tibia, sequela
S82.301A - S82.302S Unspecified fracture of lower end of right tibia, initial encounter for closed fracture - Unspecified fracture of lower end of left tibia, sequela
S82.311A - S82.312S Torus fracture of lower end of right tibia, initial encounter for closed fracture - Torus fracture of lower end of left tibia, sequela
S82.391A - S82.392S Other fracture of lower end of right tibia, initial encounter for closed fracture - Other fracture of lower end of left tibia, sequela
S82.401A - S82.402S Unspecified fracture of shaft of right fibula, initial encounter for closed fracture - Unspecified fracture of shaft of left fibula, sequela
S82.421A - S82.422S Displaced transverse fracture of shaft of right fibula, initial encounter for closed fracture - Displaced transverse fracture of shaft of left fibula, sequela
S82.424A - S82.425S Nondisplaced transverse fracture of shaft of right fibula, initial encounter for closed fracture - Nondisplaced transverse fracture of shaft of left fibula, sequela
S82.431A - S82.432S Displaced oblique fracture of shaft of right fibula, initial encounter for closed fracture - Displaced oblique fracture of shaft of left fibula, sequela
S82.434A - S82.435S Nondisplaced oblique fracture of shaft of right fibula, initial encounter for closed fracture - Nondisplaced oblique fracture of shaft of left fibula, sequela
S82.441A - S82.442S Displaced spiral fracture of shaft of right fibula, initial encounter for closed fracture - Displaced spiral fracture of shaft of left fibula, sequela
S82.444A - S82.445S Nondisplaced spiral fracture of shaft of right fibula, initial encounter for closed fracture - Nondisplaced spiral fracture of shaft of left fibula, sequela
S82.451A - S82.452S Displaced comminuted fracture of shaft of right fibula, initial encounter for closed fracture - Displaced comminuted fracture of shaft of left fibula, sequela
S82.454A - S82.455S Nondisplaced comminuted fracture of shaft of right fibula, initial encounter for closed fracture - Nondisplaced comminuted fracture of shaft of left fibula, sequela
S82.461A - S82.462S Displaced segmental fracture of shaft of right fibula, initial encounter for closed fracture - Displaced segmental fracture of shaft of left fibula, sequela
S82.464A - S82.465S Nondisplaced segmental fracture of shaft of right fibula, initial encounter for closed fracture - Nondisplaced segmental fracture of shaft of left fibula, sequela
S82.491A - S82.492S Other fracture of shaft of right fibula, initial encounter for closed fracture - Other fracture of shaft of left fibula, sequela
S82.51XA - S82.52XS Displaced fracture of medial malleolus of right tibia, initial encounter for closed fracture - Displaced fracture of medial malleolus of left tibia, sequela
S82.54XA - S82.55XS Nondisplaced fracture of medial malleolus of right tibia, initial encounter for closed fracture - Nondisplaced fracture of medial malleolus of left tibia, sequela
S82.61XA - S82.62XS Displaced fracture of lateral malleolus of right fibula, initial encounter for closed fracture - Displaced fracture of lateral malleolus of left fibula, sequela
S82.64XA - S82.65XS Nondisplaced fracture of lateral malleolus of right fibula, initial encounter for closed fracture - Nondisplaced fracture of lateral malleolus of left fibula, sequela
S82.811A - S82.812S Torus fracture of upper end of right fibula, initial encounter for closed fracture - Torus fracture of upper end of left fibula, sequela
S82.821A - S82.822S Torus fracture of lower end of right fibula, initial encounter for closed fracture - Torus fracture of lower end of left fibula, sequela
S82.831A - S82.832S Other fracture of upper and lower end of right fibula, initial encounter for closed fracture - Other fracture of upper and lower end of left fibula, sequela
S82.841A - S82.842S Displaced bimalleolar fracture of right lower leg, initial encounter for closed fracture - Displaced bimalleolar fracture of left lower leg, sequela
S82.844A - S82.845S Nondisplaced bimalleolar fracture of right lower leg, initial encounter for closed fracture - Nondisplaced bimalleolar fracture of left lower leg, sequela
S82.851A - S82.852S Displaced trimalleolar fracture of right lower leg, initial encounter for closed fracture - Displaced trimalleolar fracture of left lower leg, sequela
S82.854A - S82.855S Nondisplaced trimalleolar fracture of right lower leg, initial encounter for closed fracture - Nondisplaced trimalleolar fracture of left lower leg, sequela
S82.861A - S82.862S Displaced Maisonneuve's fracture of right leg, initial encounter for closed fracture - Displaced Maisonneuve's fracture of left leg, sequela
S82.864A - S82.865S Nondisplaced Maisonneuve's fracture of right leg, initial encounter for closed fracture - Nondisplaced Maisonneuve's fracture of left leg, sequela
S82.871A - S82.872S Displaced pilon fracture of right tibia, initial encounter for closed fracture - Displaced pilon fracture of left tibia, sequela
S82.874A - S82.875S Nondisplaced pilon fracture of right tibia, initial encounter for closed fracture - Nondisplaced pilon fracture of left tibia, sequela
S82.891A - S82.892S Other fracture of right lower leg, initial encounter for closed fracture - Other fracture of left lower leg, sequela
S82.91XA - S82.92XS Unspecified fracture of right lower leg, initial encounter for closed fracture - Unspecified fracture of left lower leg, sequela
S83.001A - S83.002S Unspecified subluxation of right patella, initial encounter - Unspecified subluxation of left patella, sequela
S83.004A - S83.005S Unspecified dislocation of right patella, initial encounter - Unspecified dislocation of left patella, sequela
S83.011A - S83.012S Lateral subluxation of right patella, initial encounter - Lateral subluxation of left patella, sequela
S83.014A - S83.015S Lateral dislocation of right patella, initial encounter - Lateral dislocation of left patella, sequela
S83.091A - S83.092S Other subluxation of right patella, initial encounter - Other subluxation of left patella, sequela
S83.094A - S83.095S Other dislocation of right patella, initial encounter - Other dislocation of left patella, sequela
S83.101A - S83.102S Unspecified subluxation of right knee, initial encounter - Unspecified subluxation of left knee, sequela
S83.104A - S83.105S Unspecified dislocation of right knee, initial encounter - Unspecified dislocation of left knee, sequela
S83.111A - S83.112S Anterior subluxation of proximal end of tibia, right knee, initial encounter - Anterior subluxation of proximal end of tibia, left knee, sequela
S83.114A - S83.115S Anterior dislocation of proximal end of tibia, right knee, initial encounter - Anterior dislocation of proximal end of tibia, left knee, sequela
S83.121A - S83.122S Posterior subluxation of proximal end of tibia, right knee, initial encounter - Posterior subluxation of proximal end of tibia, left knee, sequela
S83.124A - S83.125S Posterior dislocation of proximal end of tibia, right knee, initial encounter - Posterior dislocation of proximal end of tibia, left knee, sequela
S83.131A - S83.132S Medial subluxation of proximal end of tibia, right knee, initial encounter - Medial subluxation of proximal end of tibia, left knee, sequela
S83.134A - S83.135S Medial dislocation of proximal end of tibia, right knee, initial encounter - Medial dislocation of proximal end of tibia, left knee, sequela
S83.141A - S83.142S Lateral subluxation of proximal end of tibia, right knee, initial encounter - Lateral subluxation of proximal end of tibia, left knee, sequela
S83.144A - S83.145S Lateral dislocation of proximal end of tibia, right knee, initial encounter - Lateral dislocation of proximal end of tibia, left knee, sequela
S83.191A - S83.192S Other subluxation of right knee, initial encounter - Other subluxation of left knee, sequela
S83.194A - S83.195S Other dislocation of right knee, initial encounter - Other dislocation of left knee, sequela
S83.200A - S83.201S Bucket-handle tear of unspecified meniscus, current injury, right knee, initial encounter - Bucket-handle tear of unspecified meniscus, current injury, left knee, sequela
S83.203A - S83.204S Other tear of unspecified meniscus, current injury, right knee, initial encounter - Other tear of unspecified meniscus, current injury, left knee, sequela
S83.206A - S83.207S Unspecified tear of unspecified meniscus, current injury, right knee, initial encounter - Unspecified tear of unspecified meniscus, current injury, left knee, sequela
S83.211A - S83.212S Bucket-handle tear of medial meniscus, current injury, right knee, initial encounter - Bucket-handle tear of medial meniscus, current injury, left knee, sequela
S83.221A - S83.222A Peripheral tear of medial meniscus, current injury, right knee, initial encounter - Peripheral tear of medial meniscus, current injury, left knee, initial encounter
S83.231A - S83.232S Complex tear of medial meniscus, current injury, right knee, initial encounter - Complex tear of medial meniscus, current injury, left knee, sequela
S83.241A - S83.242S Other tear of medial meniscus, current injury, right knee, initial encounter - Other tear of medial meniscus, current injury, left knee, sequela
S83.251A - S83.252S Bucket-handle tear of lateral meniscus, current injury, right knee, initial encounter - Bucket-handle tear of lateral meniscus, current injury, left knee, sequela
S83.261A - S83.262S Peripheral tear of lateral meniscus, current injury, right knee, initial encounter - Peripheral tear of lateral meniscus, current injury, left knee, sequela
S83.271A - S83.272S Complex tear of lateral meniscus, current injury, right knee, initial encounter - Complex tear of lateral meniscus, current injury, left knee, sequela
S83.281A - S83.282S Other tear of lateral meniscus, current injury, right knee, initial encounter - Other tear of lateral meniscus, current injury, left knee, sequela
S83.31XA - S83.32XS Tear of articular cartilage of right knee, current, initial encounter - Tear of articular cartilage of left knee, current, sequela
S83.401A - S83.402S Sprain of unspecified collateral ligament of right knee, initial encounter - Sprain of unspecified collateral ligament of left knee, sequela
S83.411A - S83.412S Sprain of medial collateral ligament of right knee, initial encounter - Sprain of medial collateral ligament of left knee, sequela
S83.421A - S83.422S Sprain of lateral collateral ligament of right knee, initial encounter - Sprain of lateral collateral ligament of left knee, sequela
S83.501A - S83.502S Sprain of unspecified cruciate ligament of right knee, initial encounter - Sprain of unspecified cruciate ligament of left knee, sequela
S83.511A - S83.512S Sprain of anterior cruciate ligament of right knee, initial encounter - Sprain of anterior cruciate ligament of left knee, sequela
S83.521A - S83.522S Sprain of posterior cruciate ligament of right knee, initial encounter - Sprain of posterior cruciate ligament of left knee, sequela
S83.8X1A - S83.8X2S Sprain of other specified parts of right knee, initial encounter - Sprain of other specified parts of left knee, sequela
S86.111A - S86.112S Strain of other muscle(s) and tendon(s) of posterior muscle group at lower leg level, right leg, initial encounter - Strain of other muscle(s) and tendon(s) of posterior muscle group at lower leg level, left leg, sequela
S86.211A - S86.212S Strain of muscle(s) and tendon(s) of anterior muscle group at lower leg level, right leg, initial encounter - Strain of muscle(s) and tendon(s) of anterior muscle group at lower leg level, left leg, sequela
S86.311A - S86.312S Strain of muscle(s) and tendon(s) of peroneal muscle group at lower leg level, right leg, initial encounter - Strain of muscle(s) and tendon(s) of peroneal muscle group at lower leg level, left leg, sequela
S86.811A - S86.812S Strain of other muscle(s) and tendon(s) at lower leg level, right leg, initial encounter - Strain of other muscle(s) and tendon(s) at lower leg level, left leg, sequela
S89.001A - S89.002S Unspecified physeal fracture of upper end of right tibia, initial encounter for closed fracture - Unspecified physeal fracture of upper end of left tibia, sequela
S89.011A - S89.012S Salter-Harris Type I physeal fracture of upper end of right tibia, initial encounter for closed fracture - Salter-Harris Type I physeal fracture of upper end of left tibia, sequela
S89.021A - S89.022S Salter-Harris Type II physeal fracture of upper end of right tibia, initial encounter for closed fracture - Salter-Harris Type II physeal fracture of upper end of left tibia, sequela
S89.031A - S89.032S Salter-Harris Type III physeal fracture of upper end of right tibia, initial encounter for closed fracture - Salter-Harris Type III physeal fracture of upper end of left tibia, sequela
S89.041A - S89.042S Salter-Harris Type IV physeal fracture of upper end of right tibia, initial encounter for closed fracture - Salter-Harris Type IV physeal fracture of upper end of left tibia, sequela
S89.091A - S89.092S Other physeal fracture of upper end of right tibia, initial encounter for closed fracture - Other physeal fracture of upper end of left tibia, sequela
S89.101A - S89.102S Unspecified physeal fracture of lower end of right tibia, initial encounter for closed fracture - Unspecified physeal fracture of lower end of left tibia, sequela
S89.111A - S89.112S Salter-Harris Type I physeal fracture of lower end of right tibia, initial encounter for closed fracture - Salter-Harris Type I physeal fracture of lower end of left tibia, sequela
S89.121A - S89.122S Salter-Harris Type II physeal fracture of lower end of right tibia, initial encounter for closed fracture - Salter-Harris Type II physeal fracture of lower end of left tibia, sequela
S89.131A - S89.132S Salter-Harris Type III physeal fracture of lower end of right tibia, initial encounter for closed fracture - Salter-Harris Type III physeal fracture of lower end of left tibia, sequela
S89.141A - S89.142S Salter-Harris Type IV physeal fracture of lower end of right tibia, initial encounter for closed fracture - Salter-Harris Type IV physeal fracture of lower end of left tibia, sequela
S89.191A - S89.192S Other physeal fracture of lower end of right tibia, initial encounter for closed fracture - Other physeal fracture of lower end of left tibia, sequela
S89.201A - S89.202S Unspecified physeal fracture of upper end of right fibula, initial encounter for closed fracture - Unspecified physeal fracture of upper end of left fibula, sequela
S89.211A - S89.212S Salter-Harris Type I physeal fracture of upper end of right fibula, initial encounter for closed fracture - Salter-Harris Type I physeal fracture of upper end of left fibula, sequela
S89.221A - S89.222S Salter-Harris Type II physeal fracture of upper end of right fibula, initial encounter for closed fracture - Salter-Harris Type II physeal fracture of upper end of left fibula, sequela
S89.291A - S89.292S Other physeal fracture of upper end of right fibula, initial encounter for closed fracture - Other physeal fracture of upper end of left fibula, sequela
S89.301A - S89.302S Unspecified physeal fracture of lower end of right fibula, initial encounter for closed fracture - Unspecified physeal fracture of lower end of left fibula, sequela
S89.311A - S89.312S Salter-Harris Type I physeal fracture of lower end of right fibula, initial encounter for closed fracture - Salter-Harris Type I physeal fracture of lower end of left fibula, sequela
S89.321A - S89.322S Salter-Harris Type II physeal fracture of lower end of right fibula, initial encounter for closed fracture - Salter-Harris Type II physeal fracture of lower end of left fibula, sequela
S89.391A - S89.392S Other physeal fracture of lower end of right fibula, initial encounter for closed fracture - Other physeal fracture of lower end of left fibula, sequela
T84.012A - T84.013S Broken internal right knee prosthesis, initial encounter - Broken internal left knee prosthesis, sequela
T84.022A - T84.023S Instability of internal right knee prosthesis, initial encounter - Instability of internal left knee prosthesis, sequela
T84.032A - T84.033S Mechanical loosening of internal right knee prosthetic joint, initial encounter - Mechanical loosening of internal left knee prosthetic joint, sequela
T84.052A - T84.053S Periprosthetic osteolysis of internal prosthetic right knee joint, initial encounter - Periprosthetic osteolysis of internal prosthetic left knee joint, sequela
T84.062A - T84.063S Wear of articular bearing surface of internal prosthetic right knee joint, initial encounter - Wear of articular bearing surface of internal prosthetic left knee joint, sequela
T84.092A - T84.093S Other mechanical complication of internal right knee prosthesis, initial encounter - Other mechanical complication of internal left knee prosthesis, sequela
T84.114A - T84.117S Breakdown (mechanical) of internal fixation device of right femur, initial encounter - Breakdown (mechanical) of internal fixation device of bone of left lower leg, sequela
T84.124A - T84.127S Displacement of internal fixation device of right femur, initial encounter - Displacement of internal fixation device of bone of left lower leg, sequela
T84.194A - T84.197S Other mechanical complication of internal fixation device of right femur, initial encounter - Other mechanical complication of internal fixation device of bone of left lower leg, sequela
T84.410A - T84.410S Breakdown (mechanical) of muscle and tendon graft, initial encounter - Breakdown (mechanical) of muscle and tendon graft, sequela
T84.420A - T84.420S Displacement of muscle and tendon graft, initial encounter - Displacement of muscle and tendon graft, sequela
T84.498A - T84.498S Other mechanical complication of other internal orthopedic devices, implants and grafts, initial encounter - Other mechanical complication of other internal orthopedic devices, implants and grafts, sequela
T84.53XA - T84.54XS Infection and inflammatory reaction due to internal right knee prosthesis, initial encounter - Infection and inflammatory reaction due to internal left knee prosthesis, sequela
T84.81XA - T84.89XS Embolism due to internal orthopedic prosthetic devices, implants and grafts, initial encounter - Other specified complication of internal orthopedic prosthetic devices, implants and grafts, sequela
Z96.651 - Z96.653 Presence of right artificial knee joint - Presence of artificial knee joint, bilateral

Group 3

Group 3 Paragraph

For HCPCS Codes L1840:

Group 3 Codes
CodeDescription
M22.2X1 Patellofemoral disorders, right knee
M22.2X2 Patellofemoral disorders, left knee
M22.3X1 Other derangements of patella, right knee
M22.3X2 Other derangements of patella, left knee
M22.8X1 Other disorders of patella, right knee
M22.8X2 Other disorders of patella, left knee
M22.91 Unspecified disorder of patella, right knee
M22.92 Unspecified disorder of patella, left knee
M23.51 Chronic instability of knee, right knee
M23.52 Chronic instability of knee, left knee
M23.601 Other spontaneous disruption of unspecified ligament of right knee
M23.602 Other spontaneous disruption of unspecified ligament of left knee
M23.611 Other spontaneous disruption of anterior cruciate ligament of right knee
M23.612 Other spontaneous disruption of anterior cruciate ligament of left knee
M23.621 Other spontaneous disruption of posterior cruciate ligament of right knee
M23.622 Other spontaneous disruption of posterior cruciate ligament of left knee
M23.631 Other spontaneous disruption of medial collateral ligament of right knee
M23.632 Other spontaneous disruption of medial collateral ligament of left knee
M23.641 Other spontaneous disruption of lateral collateral ligament of right knee
M23.642 Other spontaneous disruption of lateral collateral ligament of left knee
M23.671 Other spontaneous disruption of capsular ligament of right knee
M23.672 Other spontaneous disruption of capsular ligament of left knee
M23.8X1 Other internal derangements of right knee
M23.8X2 Other internal derangements of left knee
M23.91 Unspecified internal derangement of right knee
M23.92 Unspecified internal derangement of left knee

Group 4

Group 4 Paragraph

For HCPCS Codes L1832, L1833, L1843, L1844, L1845, L1846, L1851 and L1852:

Group 4 Codes
CodeDescription
G04.1 Tropical spastic paraplegia
G35 Multiple sclerosis
G57.01 Lesion of sciatic nerve, right lower limb
G57.02 Lesion of sciatic nerve, left lower limb
G57.03 Lesion of sciatic nerve, bilateral lower limbs
G57.21 Lesion of femoral nerve, right lower limb
G57.22 Lesion of femoral nerve, left lower limb
G57.23 Lesion of femoral nerve, bilateral lower limbs
G80.9 Cerebral palsy, unspecified
G81.91 - G81.94 Hemiplegia, unspecified affecting right dominant side - Hemiplegia, unspecified affecting left nondominant side
G82.20 - G82.22 Paraplegia, unspecified - Paraplegia, incomplete
M05.061 Felty's syndrome, right knee
M05.062 Felty's syndrome, left knee
M05.261 Rheumatoid vasculitis with rheumatoid arthritis of right knee
M05.262 Rheumatoid vasculitis with rheumatoid arthritis of left knee
M05.361 Rheumatoid heart disease with rheumatoid arthritis of right knee
M05.362 Rheumatoid heart disease with rheumatoid arthritis of left knee
M05.461 Rheumatoid myopathy with rheumatoid arthritis of right knee
M05.462 Rheumatoid myopathy with rheumatoid arthritis of left knee
M05.561 Rheumatoid polyneuropathy with rheumatoid arthritis of right knee
M05.562 Rheumatoid polyneuropathy with rheumatoid arthritis of left knee
M05.661 Rheumatoid arthritis of right knee with involvement of other organs and systems
M05.662 Rheumatoid arthritis of left knee with involvement of other organs and systems
M05.761 Rheumatoid arthritis with rheumatoid factor of right knee without organ or systems involvement
M05.762 Rheumatoid arthritis with rheumatoid factor of left knee without organ or systems involvement
M05.861 Other rheumatoid arthritis with rheumatoid factor of right knee
M05.862 Other rheumatoid arthritis with rheumatoid factor of left knee
M06.061 Rheumatoid arthritis without rheumatoid factor, right knee
M06.062 Rheumatoid arthritis without rheumatoid factor, left knee
M06.1 Adult-onset Still's disease
M06.261 Rheumatoid bursitis, right knee
M06.262 Rheumatoid bursitis, left knee
M06.361 Rheumatoid nodule, right knee
M06.362 Rheumatoid nodule, left knee
M06.861 Other specified rheumatoid arthritis, right knee
M06.862 Other specified rheumatoid arthritis, left knee
M08.061 Unspecified juvenile rheumatoid arthritis, right knee
M08.062 Unspecified juvenile rheumatoid arthritis, left knee
M08.261 Juvenile rheumatoid arthritis with systemic onset, right knee
M08.262 Juvenile rheumatoid arthritis with systemic onset, left knee
M08.3 Juvenile rheumatoid polyarthritis (seronegative)
M08.461 Pauciarticular juvenile rheumatoid arthritis, right knee
M08.462 Pauciarticular juvenile rheumatoid arthritis, left knee
M08.861 Other juvenile arthritis, right knee
M08.862 Other juvenile arthritis, left knee
M08.961 Juvenile arthritis, unspecified, right knee
M08.962 Juvenile arthritis, unspecified, left knee
M12.061 Chronic postrheumatic arthropathy [Jaccoud], right knee
M12.062 Chronic postrheumatic arthropathy [Jaccoud], left knee
M17.0 Bilateral primary osteoarthritis of knee
M17.11 Unilateral primary osteoarthritis, right knee
M17.12 Unilateral primary osteoarthritis, left knee
M17.2 Bilateral post-traumatic osteoarthritis of knee
M17.31 Unilateral post-traumatic osteoarthritis, right knee
M17.32 Unilateral post-traumatic osteoarthritis, left knee
M17.4 Other bilateral secondary osteoarthritis of knee
M17.5 Other unilateral secondary osteoarthritis of knee
M17.9 Osteoarthritis of knee, unspecified
M22.2X1 Patellofemoral disorders, right knee
M22.2X2 Patellofemoral disorders, left knee
M22.3X1 Other derangements of patella, right knee
M22.3X2 Other derangements of patella, left knee
M22.41 Chondromalacia patellae, right knee
M22.42 Chondromalacia patellae, left knee
M22.8X1 Other disorders of patella, right knee
M22.8X2 Other disorders of patella, left knee
M22.91 Unspecified disorder of patella, right knee
M22.92 Unspecified disorder of patella, left knee
M23.000 Cystic meniscus, unspecified lateral meniscus, right knee
M23.001 Cystic meniscus, unspecified lateral meniscus, left knee
M23.003 Cystic meniscus, unspecified medial meniscus, right knee
M23.004 Cystic meniscus, unspecified medial meniscus, left knee
M23.006 Cystic meniscus, unspecified meniscus, right knee
M23.007 Cystic meniscus, unspecified meniscus, left knee
M23.011 Cystic meniscus, anterior horn of medial meniscus, right knee
M23.012 Cystic meniscus, anterior horn of medial meniscus, left knee
M23.021 Cystic meniscus, posterior horn of medial meniscus, right knee
M23.022 Cystic meniscus, posterior horn of medial meniscus, left knee
M23.031 Cystic meniscus, other medial meniscus, right knee
M23.032 Cystic meniscus, other medial meniscus, left knee
M23.041 Cystic meniscus, anterior horn of lateral meniscus, right knee
M23.042 Cystic meniscus, anterior horn of lateral meniscus, left knee
M23.051 Cystic meniscus, posterior horn of lateral meniscus, right knee
M23.052 Cystic meniscus, posterior horn of lateral meniscus, left knee
M23.061 Cystic meniscus, other lateral meniscus, right knee
M23.062 Cystic meniscus, other lateral meniscus, left knee
M23.200 Derangement of unspecified lateral meniscus due to old tear or injury, right knee
M23.201 Derangement of unspecified lateral meniscus due to old tear or injury, left knee
M23.203 Derangement of unspecified medial meniscus due to old tear or injury, right knee
M23.204 Derangement of unspecified medial meniscus due to old tear or injury, left knee
M23.206 Derangement of unspecified meniscus due to old tear or injury, right knee
M23.207 Derangement of unspecified meniscus due to old tear or injury, left knee
M23.211 Derangement of anterior horn of medial meniscus due to old tear or injury, right knee
M23.212 Derangement of anterior horn of medial meniscus due to old tear or injury, left knee
M23.221 Derangement of posterior horn of medial meniscus due to old tear or injury, right knee
M23.222 Derangement of posterior horn of medial meniscus due to old tear or injury, left knee
M23.231 Derangement of other medial meniscus due to old tear or injury, right knee
M23.232 Derangement of other medial meniscus due to old tear or injury, left knee
M23.241 Derangement of anterior horn of lateral meniscus due to old tear or injury, right knee
M23.242 Derangement of anterior horn of lateral meniscus due to old tear or injury, left knee
M23.251 Derangement of posterior horn of lateral meniscus due to old tear or injury, right knee
M23.252 Derangement of posterior horn of lateral meniscus due to old tear or injury, left knee
M23.261 Derangement of other lateral meniscus due to old tear or injury, right knee
M23.262 Derangement of other lateral meniscus due to old tear or injury, left knee
M23.300 Other meniscus derangements, unspecified lateral meniscus, right knee
M23.301 Other meniscus derangements, unspecified lateral meniscus, left knee
M23.303 Other meniscus derangements, unspecified medial meniscus, right knee
M23.304 Other meniscus derangements, unspecified medial meniscus, left knee
M23.306 Other meniscus derangements, unspecified meniscus, right knee
M23.307 Other meniscus derangements, unspecified meniscus, left knee
M23.311 Other meniscus derangements, anterior horn of medial meniscus, right knee
M23.312 Other meniscus derangements, anterior horn of medial meniscus, left knee
M23.321 Other meniscus derangements, posterior horn of medial meniscus, right knee
M23.322 Other meniscus derangements, posterior horn of medial meniscus, left knee
M23.331 Other meniscus derangements, other medial meniscus, right knee
M23.332 Other meniscus derangements, other medial meniscus, left knee
M23.341 Other meniscus derangements, anterior horn of lateral meniscus, right knee
M23.342 Other meniscus derangements, anterior horn of lateral meniscus, left knee
M23.351 Other meniscus derangements, posterior horn of lateral meniscus, right knee
M23.352 Other meniscus derangements, posterior horn of lateral meniscus, left knee
M23.361 Other meniscus derangements, other lateral meniscus, right knee
M23.362 Other meniscus derangements, other lateral meniscus, left knee
M23.51 Chronic instability of knee, right knee
M23.52 Chronic instability of knee, left knee
M23.601 Other spontaneous disruption of unspecified ligament of right knee
M23.602 Other spontaneous disruption of unspecified ligament of left knee
M23.611 Other spontaneous disruption of anterior cruciate ligament of right knee
M23.612 Other spontaneous disruption of anterior cruciate ligament of left knee
M23.621 Other spontaneous disruption of posterior cruciate ligament of right knee
M23.622 Other spontaneous disruption of posterior cruciate ligament of left knee
M23.631 Other spontaneous disruption of medial collateral ligament of right knee
M23.632 Other spontaneous disruption of medial collateral ligament of left knee
M23.641 Other spontaneous disruption of lateral collateral ligament of right knee
M23.642 Other spontaneous disruption of lateral collateral ligament of left knee
M23.671 Other spontaneous disruption of capsular ligament of right knee
M23.672 Other spontaneous disruption of capsular ligament of left knee
M23.8X1 Other internal derangements of right knee
M23.8X2 Other internal derangements of left knee
M23.91 Unspecified internal derangement of right knee
M23.92 Unspecified internal derangement of left knee
M66.251 Spontaneous rupture of extensor tendons, right thigh
M66.252 Spontaneous rupture of extensor tendons, left thigh
M66.261 Spontaneous rupture of extensor tendons, right lower leg
M66.262 Spontaneous rupture of extensor tendons, left lower leg
M80.051A - M80.052S Age-related osteoporosis with current pathological fracture, right femur, initial encounter for fracture - Age-related osteoporosis with current pathological fracture, left femur, sequela
M80.061A - M80.062S Age-related osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture - Age-related osteoporosis with current pathological fracture, left lower leg, sequela
M80.851A - M80.852S Other osteoporosis with current pathological fracture, right femur, initial encounter for fracture - Other osteoporosis with current pathological fracture, left femur, sequela
M80.861A - M80.862S Other osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture - Other osteoporosis with current pathological fracture, left lower leg, sequela
M84.351A - M84.352S Stress fracture, right femur, initial encounter for fracture - Stress fracture, left femur, sequela
M84.361A - M84.364S Stress fracture, right tibia, initial encounter for fracture - Stress fracture, left fibula, sequela
M84.451A - M84.452S Pathological fracture, right femur, initial encounter for fracture - Pathological fracture, left femur, sequela
M84.461A - M84.464S Pathological fracture, right tibia, initial encounter for fracture - Pathological fracture, left fibula, sequela
M84.551A - M84.552S Pathological fracture in neoplastic disease, right femur, initial encounter for fracture - Pathological fracture in neoplastic disease, left femur, sequela
M84.561A - M84.564S Pathological fracture in neoplastic disease, right tibia, initial encounter for fracture - Pathological fracture in neoplastic disease, left fibula, sequela
M84.651A - M84.652S Pathological fracture in other disease, right femur, initial encounter for fracture - Pathological fracture in other disease, left femur, sequela
M84.661A - M84.664S Pathological fracture in other disease, right tibia, initial encounter for fracture - Pathological fracture in other disease, left fibula, sequela
M87.061 Idiopathic aseptic necrosis of right tibia
M87.062 Idiopathic aseptic necrosis of left tibia
M87.064 Idiopathic aseptic necrosis of right fibula
M87.065 Idiopathic aseptic necrosis of left fibula
M87.161 Osteonecrosis due to drugs, right tibia
M87.162 Osteonecrosis due to drugs, left tibia
M87.164 Osteonecrosis due to drugs, right fibula
M87.165 Osteonecrosis due to drugs, left fibula
M87.261 Osteonecrosis due to previous trauma, right tibia
M87.262 Osteonecrosis due to previous trauma, left tibia
M87.264 Osteonecrosis due to previous trauma, right fibula
M87.265 Osteonecrosis due to previous trauma, left fibula
M87.361 Other secondary osteonecrosis, right tibia
M87.362 Other secondary osteonecrosis, left tibia
M87.364 Other secondary osteonecrosis, right fibula
M87.365 Other secondary osteonecrosis, left fibula
M87.861 Other osteonecrosis, right tibia
M87.862 Other osteonecrosis, left tibia
M87.864 Other osteonecrosis, right fibula
M87.865 Other osteonecrosis, left fibula
M90.561 Osteonecrosis in diseases classified elsewhere, right lower leg
M90.562 Osteonecrosis in diseases classified elsewhere, left lower leg
M96.661 Fracture of femur following insertion of orthopedic implant, joint prosthesis, or bone plate, right leg
M96.662 Fracture of femur following insertion of orthopedic implant, joint prosthesis, or bone plate, left leg
M96.671 Fracture of tibia or fibula following insertion of orthopedic implant, joint prosthesis, or bone plate, right leg
M96.672 Fracture of tibia or fibula following insertion of orthopedic implant, joint prosthesis, or bone plate, left leg
Q68.2 Congenital deformity of knee
Q68.6 Discoid meniscus
Q74.1 Congenital malformation of knee
S72.001A - S72.002S Fracture of unspecified part of neck of right femur, initial encounter for closed fracture - Fracture of unspecified part of neck of left femur, sequela
S72.011A - S72.012S Unspecified intracapsular fracture of right femur, initial encounter for closed fracture - Unspecified intracapsular fracture of left femur, sequela
S72.021A - S72.022S Displaced fracture of epiphysis (separation) (upper) of right femur, initial encounter for closed fracture - Displaced fracture of epiphysis (separation) (upper) of left femur, sequela
S72.024A - S72.025S Nondisplaced fracture of epiphysis (separation) (upper) of right femur, initial encounter for closed fracture - Nondisplaced fracture of epiphysis (separation) (upper) of left femur, sequela
S72.031A - S72.032S Displaced midcervical fracture of right femur, initial encounter for closed fracture - Displaced midcervical fracture of left femur, sequela
S72.034A - S72.035S Nondisplaced midcervical fracture of right femur, initial encounter for closed fracture - Nondisplaced midcervical fracture of left femur, sequela
S72.041A - S72.042S Displaced fracture of base of neck of right femur, initial encounter for closed fracture - Displaced fracture of base of neck of left femur, sequela
S72.044A - S72.045S Nondisplaced fracture of base of neck of right femur, initial encounter for closed fracture - Nondisplaced fracture of base of neck of left femur, sequela
S72.051A - S72.052S Unspecified fracture of head of right femur, initial encounter for closed fracture - Unspecified fracture of head of left femur, sequela
S72.061A - S72.062S Displaced articular fracture of head of right femur, initial encounter for closed fracture - Displaced articular fracture of head of left femur, sequela
S72.064A - S72.065S Nondisplaced articular fracture of head of right femur, initial encounter for closed fracture - Nondisplaced articular fracture of head of left femur, sequela
S72.091A - S72.092S Other fracture of head and neck of right femur, initial encounter for closed fracture - Other fracture of head and neck of left femur, sequela
S72.101A - S72.102S Unspecified trochanteric fracture of right femur, initial encounter for closed fracture - Unspecified trochanteric fracture of left femur, sequela
S72.111A - S72.112S Displaced fracture of greater trochanter of right femur, initial encounter for closed fracture - Displaced fracture of greater trochanter of left femur, sequela
S72.114A - S72.115S Nondisplaced fracture of greater trochanter of right femur, initial encounter for closed fracture - Nondisplaced fracture of greater trochanter of left femur, sequela
S72.121A - S72.122S Displaced fracture of lesser trochanter of right femur, initial encounter for closed fracture - Displaced fracture of lesser trochanter of left femur, sequela
S72.124A - S72.125S Nondisplaced fracture of lesser trochanter of right femur, initial encounter for closed fracture - Nondisplaced fracture of lesser trochanter of left femur, sequela
S72.131A - S72.132S Displaced apophyseal fracture of right femur, initial encounter for closed fracture - Displaced apophyseal fracture of left femur, sequela
S72.134A - S72.135S Nondisplaced apophyseal fracture of right femur, initial encounter for closed fracture - Nondisplaced apophyseal fracture of left femur, sequela
S72.141A - S72.142S Displaced intertrochanteric fracture of right femur, initial encounter for closed fracture - Displaced intertrochanteric fracture of left femur, sequela
S72.144A - S72.145S Nondisplaced intertrochanteric fracture of right femur, initial encounter for closed fracture - Nondisplaced intertrochanteric fracture of left femur, sequela
S72.21XA - S72.22XS Displaced subtrochanteric fracture of right femur, initial encounter for closed fracture - Displaced subtrochanteric fracture of left femur, sequela
S72.24XA - S72.25XS Nondisplaced subtrochanteric fracture of right femur, initial encounter for closed fracture - Nondisplaced subtrochanteric fracture of left femur, sequela
S72.301A - S72.302S Unspecified fracture of shaft of right femur, initial encounter for closed fracture - Unspecified fracture of shaft of left femur, sequela
S72.321A - S72.322S Displaced transverse fracture of shaft of right femur, initial encounter for closed fracture - Displaced transverse fracture of shaft of left femur, sequela
S72.324A - S72.325S Nondisplaced transverse fracture of shaft of right femur, initial encounter for closed fracture - Nondisplaced transverse fracture of shaft of left femur, sequela
S72.331A - S72.332S Displaced oblique fracture of shaft of right femur, initial encounter for closed fracture - Displaced oblique fracture of shaft of left femur, sequela
S72.334A - S72.335S Nondisplaced oblique fracture of shaft of right femur, initial encounter for closed fracture - Nondisplaced oblique fracture of shaft of left femur, sequela
S72.341A - S72.342S Displaced spiral fracture of shaft of right femur, initial encounter for closed fracture - Displaced spiral fracture of shaft of left femur, sequela
S72.344A - S72.345S Nondisplaced spiral fracture of shaft of right femur, initial encounter for closed fracture - Nondisplaced spiral fracture of shaft of left femur, sequela
S72.351A - S72.352S Displaced comminuted fracture of shaft of right femur, initial encounter for closed fracture - Displaced comminuted fracture of shaft of left femur, sequela
S72.354A - S72.355S Nondisplaced comminuted fracture of shaft of right femur, initial encounter for closed fracture - Nondisplaced comminuted fracture of shaft of left femur, sequela
S72.361A - S72.362S Displaced segmental fracture of shaft of right femur, initial encounter for closed fracture - Displaced segmental fracture of shaft of left femur, sequela
S72.364A - S72.365S Nondisplaced segmental fracture of shaft of right femur, initial encounter for closed fracture - Nondisplaced segmental fracture of shaft of left femur, sequela
S72.391A - S72.392S Other fracture of shaft of right femur, initial encounter for closed fracture - Other fracture of shaft of left femur, sequela
S72.401A - S72.402S Unspecified fracture of lower end of right femur, initial encounter for closed fracture - Unspecified fracture of lower end of left femur, sequela
S72.411A - S72.412S Displaced unspecified condyle fracture of lower end of right femur, initial encounter for closed fracture - Displaced unspecified condyle fracture of lower end of left femur, sequela
S72.414A - S72.415S Nondisplaced unspecified condyle fracture of lower end of right femur, initial encounter for closed fracture - Nondisplaced unspecified condyle fracture of lower end of left femur, sequela
S72.421A - S72.422S Displaced fracture of lateral condyle of right femur, initial encounter for closed fracture - Displaced fracture of lateral condyle of left femur, sequela
S72.424A - S72.425S Nondisplaced fracture of lateral condyle of right femur, initial encounter for closed fracture - Nondisplaced fracture of lateral condyle of left femur, sequela
S72.431A - S72.432S Displaced fracture of medial condyle of right femur, initial encounter for closed fracture - Displaced fracture of medial condyle of left femur, sequela
S72.434A - S72.435S Nondisplaced fracture of medial condyle of right femur, initial encounter for closed fracture - Nondisplaced fracture of medial condyle of left femur, sequela
S72.441A - S72.442S Displaced fracture of lower epiphysis (separation) of right femur, initial encounter for closed fracture - Displaced fracture of lower epiphysis (separation) of left femur, sequela
S72.444A - S72.445S Nondisplaced fracture of lower epiphysis (separation) of right femur, initial encounter for closed fracture - Nondisplaced fracture of lower epiphysis (separation) of left femur, sequela
S72.451A - S72.452S Displaced supracondylar fracture without intracondylar extension of lower end of right femur, initial encounter for closed fracture - Displaced supracondylar fracture without intracondylar extension of lower end of left femur, sequela
S72.454A - S72.455S Nondisplaced supracondylar fracture without intracondylar extension of lower end of right femur, initial encounter for closed fracture - Nondisplaced supracondylar fracture without intracondylar extension of lower end of left femur, sequela
S72.461A - S72.462S Displaced supracondylar fracture with intracondylar extension of lower end of right femur, initial encounter for closed fracture - Displaced supracondylar fracture with intracondylar extension of lower end of left femur, sequela
S72.464A - S72.465S Nondisplaced supracondylar fracture with intracondylar extension of lower end of right femur, initial encounter for closed fracture - Nondisplaced supracondylar fracture with intracondylar extension of lower end of left femur, sequela
S72.471A - S72.472S Torus fracture of lower end of right femur, initial encounter for closed fracture - Torus fracture of lower end of left femur, sequela
S72.491A - S72.492S Other fracture of lower end of right femur, initial encounter for closed fracture - Other fracture of lower end of left femur, sequela
S72.8X1A - S72.8X2S Other fracture of right femur, initial encounter for closed fracture - Other fracture of left femur, sequela
S72.91XA - S72.92XS Unspecified fracture of right femur, initial encounter for closed fracture - Unspecified fracture of left femur, sequela
S76.111A Strain of right quadriceps muscle, fascia and tendon, initial encounter
S76.111D Strain of right quadriceps muscle, fascia and tendon, subsequent encounter
S76.111S Strain of right quadriceps muscle, fascia and tendon, sequela
S76.112A Strain of left quadriceps muscle, fascia and tendon, initial encounter
S76.112D Strain of left quadriceps muscle, fascia and tendon, subsequent encounter
S76.112S Strain of left quadriceps muscle, fascia and tendon, sequela
S76.121A Laceration of right quadriceps muscle, fascia and tendon, initial encounter
S76.121D Laceration of right quadriceps muscle, fascia and tendon, subsequent encounter
S76.121S Laceration of right quadriceps muscle, fascia and tendon, sequela
S76.122A Laceration of left quadriceps muscle, fascia and tendon, initial encounter
S76.122D Laceration of left quadriceps muscle, fascia and tendon, subsequent encounter
S76.122S Laceration of left quadriceps muscle, fascia and tendon, sequela
S79.001A - S79.002S Unspecified physeal fracture of upper end of right femur, initial encounter for closed fracture - Unspecified physeal fracture of upper end of left femur, sequela
S79.011A - S79.012S Salter-Harris Type I physeal fracture of upper end of right femur, initial encounter for closed fracture - Salter-Harris Type I physeal fracture of upper end of left femur, sequela
S79.091A - S79.092S Other physeal fracture of upper end of right femur, initial encounter for closed fracture - Other physeal fracture of upper end of left femur, sequela
S79.101A - S79.102S Unspecified physeal fracture of lower end of right femur, initial encounter for closed fracture - Unspecified physeal fracture of lower end of left femur, sequela
S79.111A - S79.112S Salter-Harris Type I physeal fracture of lower end of right femur, initial encounter for closed fracture - Salter-Harris Type I physeal fracture of lower end of left femur, sequela
S79.121A - S79.122S Salter-Harris Type II physeal fracture of lower end of right femur, initial encounter for closed fracture - Salter-Harris Type II physeal fracture of lower end of left femur, sequela
S79.131A - S79.132S Salter-Harris Type III physeal fracture of lower end of right femur, initial encounter for closed fracture - Salter-Harris Type III physeal fracture of lower end of left femur, sequela
S79.141A - S79.142S Salter-Harris Type IV physeal fracture of lower end of right femur, initial encounter for closed fracture - Salter-Harris Type IV physeal fracture of lower end of left femur, sequela
S79.191A - S79.192S Other physeal fracture of lower end of right femur, initial encounter for closed fracture - Other physeal fracture of lower end of left femur, sequela
S82.001A - S82.002S Unspecified fracture of right patella, initial encounter for closed fracture - Unspecified fracture of left patella, sequela
S82.011A - S82.012S Displaced osteochondral fracture of right patella, initial encounter for closed fracture - Displaced osteochondral fracture of left patella, sequela
S82.014A - S82.015S Nondisplaced osteochondral fracture of right patella, initial encounter for closed fracture - Nondisplaced osteochondral fracture of left patella, sequela
S82.021A - S82.022S Displaced longitudinal fracture of right patella, initial encounter for closed fracture - Displaced longitudinal fracture of left patella, sequela
S82.024A - S82.025S Nondisplaced longitudinal fracture of right patella, initial encounter for closed fracture - Nondisplaced longitudinal fracture of left patella, sequela
S82.031A - S82.032S Displaced transverse fracture of right patella, initial encounter for closed fracture - Displaced transverse fracture of left patella, sequela
S82.034A - S82.035S Nondisplaced transverse fracture of right patella, initial encounter for closed fracture - Nondisplaced transverse fracture of left patella, sequela
S82.041A - S82.042S Displaced comminuted fracture of right patella, initial encounter for closed fracture - Displaced comminuted fracture of left patella, sequela
S82.044A - S82.045S Nondisplaced comminuted fracture of right patella, initial encounter for closed fracture - Nondisplaced comminuted fracture of left patella, sequela
S82.091A - S82.092S Other fracture of right patella, initial encounter for closed fracture - Other fracture of left patella, sequela
S82.101A - S82.102S Unspecified fracture of upper end of right tibia, initial encounter for closed fracture - Unspecified fracture of upper end of left tibia, sequela
S82.111A - S82.112S Displaced fracture of right tibial spine, initial encounter for closed fracture - Displaced fracture of left tibial spine, sequela
S82.114A - S82.115S Nondisplaced fracture of right tibial spine, initial encounter for closed fracture - Nondisplaced fracture of left tibial spine, sequela
S82.121A - S82.122S Displaced fracture of lateral condyle of right tibia, initial encounter for closed fracture - Displaced fracture of lateral condyle of left tibia, sequela
S82.124A - S82.125S Nondisplaced fracture of lateral condyle of right tibia, initial encounter for closed fracture - Nondisplaced fracture of lateral condyle of left tibia, sequela
S82.131A - S82.132S Displaced fracture of medial condyle of right tibia, initial encounter for closed fracture - Displaced fracture of medial condyle of left tibia, sequela
S82.134A - S82.135S Nondisplaced fracture of medial condyle of right tibia, initial encounter for closed fracture - Nondisplaced fracture of medial condyle of left tibia, sequela
S82.141A - S82.142S Displaced bicondylar fracture of right tibia, initial encounter for closed fracture - Displaced bicondylar fracture of left tibia, sequela
S82.144A - S82.145S Nondisplaced bicondylar fracture of right tibia, initial encounter for closed fracture - Nondisplaced bicondylar fracture of left tibia, sequela
S82.151A - S82.152S Displaced fracture of right tibial tuberosity, initial encounter for closed fracture - Displaced fracture of left tibial tuberosity, sequela
S82.154A - S82.155S Nondisplaced fracture of right tibial tuberosity, initial encounter for closed fracture - Nondisplaced fracture of left tibial tuberosity, sequela
S82.161A - S82.162S Torus fracture of upper end of right tibia, initial encounter for closed fracture - Torus fracture of upper end of left tibia, sequela
S82.191A - S82.192S Other fracture of upper end of right tibia, initial encounter for closed fracture - Other fracture of upper end of left tibia, sequela
S82.201A - S82.202S Unspecified fracture of shaft of right tibia, initial encounter for closed fracture - Unspecified fracture of shaft of left tibia, sequela
S82.221A - S82.222S Displaced transverse fracture of shaft of right tibia, initial encounter for closed fracture - Displaced transverse fracture of shaft of left tibia, sequela
S82.224A - S82.225S Nondisplaced transverse fracture of shaft of right tibia, initial encounter for closed fracture - Nondisplaced transverse fracture of shaft of left tibia, sequela
S82.231A - S82.232S Displaced oblique fracture of shaft of right tibia, initial encounter for closed fracture - Displaced oblique fracture of shaft of left tibia, sequela
S82.234A - S82.235S Nondisplaced oblique fracture of shaft of right tibia, initial encounter for closed fracture - Nondisplaced oblique fracture of shaft of left tibia, sequela
S82.241A - S82.242S Displaced spiral fracture of shaft of right tibia, initial encounter for closed fracture - Displaced spiral fracture of shaft of left tibia, sequela
S82.244A - S82.245S Nondisplaced spiral fracture of shaft of right tibia, initial encounter for closed fracture - Nondisplaced spiral fracture of shaft of left tibia, sequela
S82.251A - S82.252S Displaced comminuted fracture of shaft of right tibia, initial encounter for closed fracture - Displaced comminuted fracture of shaft of left tibia, sequela
S82.254A - S82.255S Nondisplaced comminuted fracture of shaft of right tibia, initial encounter for closed fracture - Nondisplaced comminuted fracture of shaft of left tibia, sequela
S82.261A - S82.262S Displaced segmental fracture of shaft of right tibia, initial encounter for closed fracture - Displaced segmental fracture of shaft of left tibia, sequela
S82.264A - S82.265S Nondisplaced segmental fracture of shaft of right tibia, initial encounter for closed fracture - Nondisplaced segmental fracture of shaft of left tibia, sequela
S82.291A - S82.292S Other fracture of shaft of right tibia, initial encounter for closed fracture - Other fracture of shaft of left tibia, sequela
S82.301A - S82.302S Unspecified fracture of lower end of right tibia, initial encounter for closed fracture - Unspecified fracture of lower end of left tibia, sequela
S82.311A - S82.312S Torus fracture of lower end of right tibia, initial encounter for closed fracture - Torus fracture of lower end of left tibia, sequela
S82.391A - S82.392S Other fracture of lower end of right tibia, initial encounter for closed fracture - Other fracture of lower end of left tibia, sequela
S82.401A - S82.402S Unspecified fracture of shaft of right fibula, initial encounter for closed fracture - Unspecified fracture of shaft of left fibula, sequela
S82.421A - S82.422S Displaced transverse fracture of shaft of right fibula, initial encounter for closed fracture - Displaced transverse fracture of shaft of left fibula, sequela
S82.424A - S82.425S Nondisplaced transverse fracture of shaft of right fibula, initial encounter for closed fracture - Nondisplaced transverse fracture of shaft of left fibula, sequela
S82.431A - S82.432S Displaced oblique fracture of shaft of right fibula, initial encounter for closed fracture - Displaced oblique fracture of shaft of left fibula, sequela
S82.434A - S82.435S Nondisplaced oblique fracture of shaft of right fibula, initial encounter for closed fracture - Nondisplaced oblique fracture of shaft of left fibula, sequela
S82.441A - S82.442S Displaced spiral fracture of shaft of right fibula, initial encounter for closed fracture - Displaced spiral fracture of shaft of left fibula, sequela
S82.444A - S82.445S Nondisplaced spiral fracture of shaft of right fibula, initial encounter for closed fracture - Nondisplaced spiral fracture of shaft of left fibula, sequela
S82.451A - S82.452S Displaced comminuted fracture of shaft of right fibula, initial encounter for closed fracture - Displaced comminuted fracture of shaft of left fibula, sequela
S82.454A - S82.455S Nondisplaced comminuted fracture of shaft of right fibula, initial encounter for closed fracture - Nondisplaced comminuted fracture of shaft of left fibula, sequela
S82.461A - S82.462S Displaced segmental fracture of shaft of right fibula, initial encounter for closed fracture - Displaced segmental fracture of shaft of left fibula, sequela
S82.464A - S82.465S Nondisplaced segmental fracture of shaft of right fibula, initial encounter for closed fracture - Nondisplaced segmental fracture of shaft of left fibula, sequela
S82.491A - S82.492S Other fracture of shaft of right fibula, initial encounter for closed fracture - Other fracture of shaft of left fibula, sequela
S82.51XA - S82.52XS Displaced fracture of medial malleolus of right tibia, initial encounter for closed fracture - Displaced fracture of medial malleolus of left tibia, sequela
S82.54XA - S82.55XS Nondisplaced fracture of medial malleolus of right tibia, initial encounter for closed fracture - Nondisplaced fracture of medial malleolus of left tibia, sequela
S82.61XA - S82.62XS Displaced fracture of lateral malleolus of right fibula, initial encounter for closed fracture - Displaced fracture of lateral malleolus of left fibula, sequela
S82.64XA - S82.65XS Nondisplaced fracture of lateral malleolus of right fibula, initial encounter for closed fracture - Nondisplaced fracture of lateral malleolus of left fibula, sequela
S82.811A - S82.812S Torus fracture of upper end of right fibula, initial encounter for closed fracture - Torus fracture of upper end of left fibula, sequela
S82.821A - S82.822S Torus fracture of lower end of right fibula, initial encounter for closed fracture - Torus fracture of lower end of left fibula, sequela
S82.831A - S82.832S Other fracture of upper and lower end of right fibula, initial encounter for closed fracture - Other fracture of upper and lower end of left fibula, sequela
S82.841A - S82.842S Displaced bimalleolar fracture of right lower leg, initial encounter for closed fracture - Displaced bimalleolar fracture of left lower leg, sequela
S82.844A - S82.845S Nondisplaced bimalleolar fracture of right lower leg, initial encounter for closed fracture - Nondisplaced bimalleolar fracture of left lower leg, sequela
S82.851A - S82.852S Displaced trimalleolar fracture of right lower leg, initial encounter for closed fracture - Displaced trimalleolar fracture of left lower leg, sequela
S82.854A - S82.855S Nondisplaced trimalleolar fracture of right lower leg, initial encounter for closed fracture - Nondisplaced trimalleolar fracture of left lower leg, sequela
S82.861A - S82.862S Displaced Maisonneuve's fracture of right leg, initial encounter for closed fracture - Displaced Maisonneuve's fracture of left leg, sequela
S82.864A - S82.865S Nondisplaced Maisonneuve's fracture of right leg, initial encounter for closed fracture - Nondisplaced Maisonneuve's fracture of left leg, sequela
S82.871A - S82.872S Displaced pilon fracture of right tibia, initial encounter for closed fracture - Displaced pilon fracture of left tibia, sequela
S82.874A - S82.875S Nondisplaced pilon fracture of right tibia, initial encounter for closed fracture - Nondisplaced pilon fracture of left tibia, sequela
S82.891A - S82.892S Other fracture of right lower leg, initial encounter for closed fracture - Other fracture of left lower leg, sequela
S82.91XA - S82.92XS Unspecified fracture of right lower leg, initial encounter for closed fracture - Unspecified fracture of left lower leg, sequela
S83.001A - S83.002S Unspecified subluxation of right patella, initial encounter - Unspecified subluxation of left patella, sequela
S83.004A - S83.005S Unspecified dislocation of right patella, initial encounter - Unspecified dislocation of left patella, sequela
S83.011A - S83.012S Lateral subluxation of right patella, initial encounter - Lateral subluxation of left patella, sequela
S83.014A - S83.015S Lateral dislocation of right patella, initial encounter - Lateral dislocation of left patella, sequela
S83.091A - S83.092S Other subluxation of right patella, initial encounter - Other subluxation of left patella, sequela
S83.094A - S83.095S Other dislocation of right patella, initial encounter - Other dislocation of left patella, sequela
S83.101A - S83.102S Unspecified subluxation of right knee, initial encounter - Unspecified subluxation of left knee, sequela
S83.104A - S83.105S Unspecified dislocation of right knee, initial encounter - Unspecified dislocation of left knee, sequela
S83.111A - S83.112S Anterior subluxation of proximal end of tibia, right knee, initial encounter - Anterior subluxation of proximal end of tibia, left knee, sequela
S83.114A - S83.115S Anterior dislocation of proximal end of tibia, right knee, initial encounter - Anterior dislocation of proximal end of tibia, left knee, sequela
S83.121A - S83.122S Posterior subluxation of proximal end of tibia, right knee, initial encounter - Posterior subluxation of proximal end of tibia, left knee, sequela
S83.124A - S83.125S Posterior dislocation of proximal end of tibia, right knee, initial encounter - Posterior dislocation of proximal end of tibia, left knee, sequela
S83.131A - S83.132S Medial subluxation of proximal end of tibia, right knee, initial encounter - Medial subluxation of proximal end of tibia, left knee, sequela
S83.134A - S83.135S Medial dislocation of proximal end of tibia, right knee, initial encounter - Medial dislocation of proximal end of tibia, left knee, sequela
S83.141A - S83.142S Lateral subluxation of proximal end of tibia, right knee, initial encounter - Lateral subluxation of proximal end of tibia, left knee, sequela
S83.144A - S83.145S Lateral dislocation of proximal end of tibia, right knee, initial encounter - Lateral dislocation of proximal end of tibia, left knee, sequela
S83.191A - S83.192S Other subluxation of right knee, initial encounter - Other subluxation of left knee, sequela
S83.194A - S83.195S Other dislocation of right knee, initial encounter - Other dislocation of left knee, sequela
S83.200A - S83.201S Bucket-handle tear of unspecified meniscus, current injury, right knee, initial encounter - Bucket-handle tear of unspecified meniscus, current injury, left knee, sequela
S83.203A - S83.204S Other tear of unspecified meniscus, current injury, right knee, initial encounter - Other tear of unspecified meniscus, current injury, left knee, sequela
S83.206A - S83.207S Unspecified tear of unspecified meniscus, current injury, right knee, initial encounter - Unspecified tear of unspecified meniscus, current injury, left knee, sequela
S83.211A - S83.212S Bucket-handle tear of medial meniscus, current injury, right knee, initial encounter - Bucket-handle tear of medial meniscus, current injury, left knee, sequela
S83.221A - S83.222A Peripheral tear of medial meniscus, current injury, right knee, initial encounter - Peripheral tear of medial meniscus, current injury, left knee, initial encounter
S83.231A - S83.232S Complex tear of medial meniscus, current injury, right knee, initial encounter - Complex tear of medial meniscus, current injury, left knee, sequela
S83.241A - S83.242S Other tear of medial meniscus, current injury, right knee, initial encounter - Other tear of medial meniscus, current injury, left knee, sequela
S83.251A - S83.252S Bucket-handle tear of lateral meniscus, current injury, right knee, initial encounter - Bucket-handle tear of lateral meniscus, current injury, left knee, sequela
S83.261A - S83.262S Peripheral tear of lateral meniscus, current injury, right knee, initial encounter - Peripheral tear of lateral meniscus, current injury, left knee, sequela
S83.271A - S83.272S Complex tear of lateral meniscus, current injury, right knee, initial encounter - Complex tear of lateral meniscus, current injury, left knee, sequela
S83.281A - S83.282S Other tear of lateral meniscus, current injury, right knee, initial encounter - Other tear of lateral meniscus, current injury, left knee, sequela
S83.31XA - S83.32XS Tear of articular cartilage of right knee, current, initial encounter - Tear of articular cartilage of left knee, current, sequela
S83.401A - S83.402S Sprain of unspecified collateral ligament of right knee, initial encounter - Sprain of unspecified collateral ligament of left knee, sequela
S83.411A - S83.412S Sprain of medial collateral ligament of right knee, initial encounter - Sprain of medial collateral ligament of left knee, sequela
S83.421A - S83.422S Sprain of lateral collateral ligament of right knee, initial encounter - Sprain of lateral collateral ligament of left knee, sequela
S83.501A - S83.502S Sprain of unspecified cruciate ligament of right knee, initial encounter - Sprain of unspecified cruciate ligament of left knee, sequela
S83.511A - S83.512S Sprain of anterior cruciate ligament of right knee, initial encounter - Sprain of anterior cruciate ligament of left knee, sequela
S83.521A - S83.522S Sprain of posterior cruciate ligament of right knee, initial encounter - Sprain of posterior cruciate ligament of left knee, sequela
S83.8X1A - S83.8X2S Sprain of other specified parts of right knee, initial encounter - Sprain of other specified parts of left knee, sequela
S86.111A - S86.112S Strain of other muscle(s) and tendon(s) of posterior muscle group at lower leg level, right leg, initial encounter - Strain of other muscle(s) and tendon(s) of posterior muscle group at lower leg level, left leg, sequela
S86.211A - S86.212S Strain of muscle(s) and tendon(s) of anterior muscle group at lower leg level, right leg, initial encounter - Strain of muscle(s) and tendon(s) of anterior muscle group at lower leg level, left leg, sequela
S86.311A - S86.312S Strain of muscle(s) and tendon(s) of peroneal muscle group at lower leg level, right leg, initial encounter - Strain of muscle(s) and tendon(s) of peroneal muscle group at lower leg level, left leg, sequela
S86.811A - S86.812S Strain of other muscle(s) and tendon(s) at lower leg level, right leg, initial encounter - Strain of other muscle(s) and tendon(s) at lower leg level, left leg, sequela
S89.001A - S89.002S Unspecified physeal fracture of upper end of right tibia, initial encounter for closed fracture - Unspecified physeal fracture of upper end of left tibia, sequela
S89.011A - S89.012S Salter-Harris Type I physeal fracture of upper end of right tibia, initial encounter for closed fracture - Salter-Harris Type I physeal fracture of upper end of left tibia, sequela
S89.021A - S89.022S Salter-Harris Type II physeal fracture of upper end of right tibia, initial encounter for closed fracture - Salter-Harris Type II physeal fracture of upper end of left tibia, sequela
S89.031A - S89.032S Salter-Harris Type III physeal fracture of upper end of right tibia, initial encounter for closed fracture - Salter-Harris Type III physeal fracture of upper end of left tibia, sequela
S89.041A - S89.042S Salter-Harris Type IV physeal fracture of upper end of right tibia, initial encounter for closed fracture - Salter-Harris Type IV physeal fracture of upper end of left tibia, sequela
S89.091A - S89.092S Other physeal fracture of upper end of right tibia, initial encounter for closed fracture - Other physeal fracture of upper end of left tibia, sequela
S89.101A - S89.102S Unspecified physeal fracture of lower end of right tibia, initial encounter for closed fracture - Unspecified physeal fracture of lower end of left tibia, sequela
S89.111A - S89.112S Salter-Harris Type I physeal fracture of lower end of right tibia, initial encounter for closed fracture - Salter-Harris Type I physeal fracture of lower end of left tibia, sequela
S89.121A - S89.122S Salter-Harris Type II physeal fracture of lower end of right tibia, initial encounter for closed fracture - Salter-Harris Type II physeal fracture of lower end of left tibia, sequela
S89.131A - S89.132S Salter-Harris Type III physeal fracture of lower end of right tibia, initial encounter for closed fracture - Salter-Harris Type III physeal fracture of lower end of left tibia, sequela
S89.141A - S89.142S Salter-Harris Type IV physeal fracture of lower end of right tibia, initial encounter for closed fracture - Salter-Harris Type IV physeal fracture of lower end of left tibia, sequela
S89.191A - S89.192S Other physeal fracture of lower end of right tibia, initial encounter for closed fracture - Other physeal fracture of lower end of left tibia, sequela
S89.201A - S89.202S Unspecified physeal fracture of upper end of right fibula, initial encounter for closed fracture - Unspecified physeal fracture of upper end of left fibula, sequela
S89.211A - S89.212S Salter-Harris Type I physeal fracture of upper end of right fibula, initial encounter for closed fracture - Salter-Harris Type I physeal fracture of upper end of left fibula, sequela
S89.221A - S89.222S Salter-Harris Type II physeal fracture of upper end of right fibula, initial encounter for closed fracture - Salter-Harris Type II physeal fracture of upper end of left fibula, sequela
S89.291A - S89.292S Other physeal fracture of upper end of right fibula, initial encounter for closed fracture - Other physeal fracture of upper end of left fibula, sequela
S89.301A - S89.302S Unspecified physeal fracture of lower end of right fibula, initial encounter for closed fracture - Unspecified physeal fracture of lower end of left fibula, sequela
S89.311A - S89.312S Salter-Harris Type I physeal fracture of lower end of right fibula, initial encounter for closed fracture - Salter-Harris Type I physeal fracture of lower end of left fibula, sequela
S89.321A - S89.322S Salter-Harris Type II physeal fracture of lower end of right fibula, initial encounter for closed fracture - Salter-Harris Type II physeal fracture of lower end of left fibula, sequela
S89.391A - S89.392S Other physeal fracture of lower end of right fibula, initial encounter for closed fracture - Other physeal fracture of lower end of left fibula, sequela
T84.012A - T84.013S Broken internal right knee prosthesis, initial encounter - Broken internal left knee prosthesis, sequela
T84.022A - T84.023S Instability of internal right knee prosthesis, initial encounter - Instability of internal left knee prosthesis, sequela
T84.032A - T84.033S Mechanical loosening of internal right knee prosthetic joint, initial encounter - Mechanical loosening of internal left knee prosthetic joint, sequela
T84.052A - T84.053S Periprosthetic osteolysis of internal prosthetic right knee joint, initial encounter - Periprosthetic osteolysis of internal prosthetic left knee joint, sequela
T84.062A - T84.063S Wear of articular bearing surface of internal prosthetic right knee joint, initial encounter - Wear of articular bearing surface of internal prosthetic left knee joint, sequela
T84.092A - T84.093S Other mechanical complication of internal right knee prosthesis, initial encounter - Other mechanical complication of internal left knee prosthesis, sequela
T84.114A - T84.117S Breakdown (mechanical) of internal fixation device of right femur, initial encounter - Breakdown (mechanical) of internal fixation device of bone of left lower leg, sequela
T84.124A - T84.127S Displacement of internal fixation device of right femur, initial encounter - Displacement of internal fixation device of bone of left lower leg, sequela
T84.194A - T84.197S Other mechanical complication of internal fixation device of right femur, initial encounter - Other mechanical complication of internal fixation device of bone of left lower leg, sequela
T84.410A - T84.410S Breakdown (mechanical) of muscle and tendon graft, initial encounter - Breakdown (mechanical) of muscle and tendon graft, sequela
T84.420A - T84.420S Displacement of muscle and tendon graft, initial encounter - Displacement of muscle and tendon graft, sequela
T84.498A - T84.498S Other mechanical complication of other internal orthopedic devices, implants and grafts, initial encounter - Other mechanical complication of other internal orthopedic devices, implants and grafts, sequela
T84.53XA - T84.54XS Infection and inflammatory reaction due to internal right knee prosthesis, initial encounter - Infection and inflammatory reaction due to internal left knee prosthesis, sequela
T84.81XA - T84.89XS Embolism due to internal orthopedic prosthetic devices, implants and grafts, initial encounter - Other specified complication of internal orthopedic prosthetic devices, implants and grafts, sequela
Z96.651 - Z96.653 Presence of right artificial knee joint - Presence of artificial knee joint, bilateral

Group 5

Group 5 Paragraph

For HCPCS Codes L1850, L1860:

Group 5 Codes
CodeDescription
M21.861 Other specified acquired deformities of right lower leg
M21.862 Other specified acquired deformities of left lower leg
Q68.2 Congenital deformity of knee

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

For the specific HCPCS codes indicated above, all ICD-10 codes that are not specified in the previous section.

Group 1 Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
02/01/2021 R12

Revision Effective Date: 02/01/2021
CODING GUIDELINES:
Added: “(CVR)” after reference to coding verification review
Added: “(PCL)” after reference to “Product Classification List”
Revised: Coding verification review information, to include incorrect coding denial language for products billed using HCPCS that require written coding verification review

03/18/2021: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

02/01/2021 R11

Revision Effective Date: 02/01/2021
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: Denial language for custom fitted orthoses to remove “with a statutory denial

11/19/2020: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

01/01/2020 R10

Revision Effective Date: 01/01/2020
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: Format of HCPCS code references, from code spans to individually-listed HCPCS
REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):
Added: Section and related information based on Final Rule 1713
CODING GUIDELINES:
Revised: L1845, L1846 and L1852 rotation control to include “and posterior”
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Revised: Section header “ICD-10 Codes that are Covered” updated to “ICD-10 Codes that Support Medical Necessity”
ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:
Revised: Section header “ICD-10 Codes that are Not Covered” updated to “ICD-10 Codes that DO NOT Support Medical Necessity”

02/27/2020: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

01/01/2019 R9

Revision Effective Date: 01/01/2019
CODING GUIDELINES:
Clarified: Custom fit requirements

03/28/2019: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

01/01/2019 R8

Revision Effective Date: 01/01/2019
CODING GUIDELINES:
Revised: Coding instructions for prefabricated orthoses without distinction of OTS or custom-fit.
Revised: RT and LT modifier billing instructions (Effective 03/01/2019)
ICD-10 CODES THAT ARE COVERED:
Added: All diagnosis codes formerly listed in the LCD
ICD-10 CODES THAT ARE NOT COVERED:
Added: Notation excluding all unlisted diagnosis codes for specified HCPCS codes from coverage

02/21/2019: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

01/01/2017 R7

Revision Effective Date: 01/01/2017
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: “Spinal” to “knee”, in reference to OTS language
CODING GUIDELINES:
Update: Velcro and Kevlar to include trademark

04/05/2018:  At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination.

 

01/01/2017 R6 Revision Effective Date: 01/01/2017
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: Brace Benefit explanation to remove reference to “counterforce” that is no longer applicable
Revised: Prefabricated and off-the-shelf (OTS) “minimal self-adjustment” regulatory definition discussion to improve consistency with regulatory definition of minimal self-adjustment
Deleted: A4466
Added: A4467
Deleted: K0901 & K0902 from the Reasonable Useful Lifetime table
Added: L1851 & L1852 to the Reasonable Useful Lifetime table
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Modifiers
CODING GUIDELINES:
Removed: Reference to classification algorithm summary
Revised: OTS and custom-fit definitions to improve consistency with regulatory definition of “minimal self-adjustment”
Added: Section on coding of elastic and similar materials
Deleted: A4466
Deleted: K0901 & K0902
Added: A4467
Added: L1851
Added: L1852
Deleted: K0901 & K0902 from the Not Separately Payable table
Added: L1851 & L1852 to the Not Separately Payable table
RELATED LOCAL COVERAGE DOCUMENTS:
Added: LCD-related Standard Documentation Requirements Language Article
10/01/2016 R5 Revision Effective Date: 10/01/2016
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Removed: Counterforce coverage requirement (does not apply to this policy)
CODING GUIDELINES:
Removed: Counterforce from the description of the brace
07/01/2016 R4 Effective July 1, 2016 oversight for DME MAC Articles is the responsibility of CGS Administrators, LLC 18003 and 17013 and Noridian Healthcare Solutions, LLC 19003 and 16013. No other changes have been made to the Articles.
06/02/2016 R3 Revision Effective Date: 06/02/2016
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: Definitions from CMS DMEPOS Quality Standards (42 CFR 424.57) and 42 CFR 414.402
CODING GUIDELINES:
Added: Custom fabricated orthosis definitions
Added: Definition of K0672
10/01/2015 R2 Revision Effective Date: 10/01/2015
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: Information for hospital and SNF reimbursement
10/01/2015 R1 Revision Effective Date: 10/01/2015
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: Codes K0901 and K0902 to Correct coding of prefabricated knee orthoses
Added: Reasonable Useful Lifetime for codes K0901 and K0902
CODING GUIDELINES:
Added: Codes K0901 and K0902 to coding guidelines
Added: Base Codes K0901 and K0902 to Addition Codes table

Associated Documents

Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
03/11/2021 02/01/2021 - N/A Currently in Effect You are here
11/13/2020 02/01/2021 - N/A Superseded View
02/21/2020 01/01/2020 - 01/31/2021 Superseded View
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Keywords

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