2018 medicare reimbursement schedule the medicare...

L Codes2018 Ceiling & Floor

Reimbursement

Style & Reimbursement Guide

GAUNTLET SPECIALTY COLLECTION THERMOPLASTIC

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L1940 $598.41-$448.81 • • • • • • •

L1960 $670.70 -$503.02 • • • • • •

L1970 $861.01-$645.75 • • • •

L2330 $475.12-$356.34 • • • • • • • • • • • • • • • •

L2820 $105.08 -$78.81 • • • • • • • • • • • • • • • •

L5000 $651.34-$488.50 • • •

L2210 $81.33-$61.00

L3400 $47.05-$35.29 • • • • •

L4631 $1782.90-$1337.17 •

L1907 $650.49-$487.87 • • •

L1904 $569.00-$426.75 •

Totals

$ 117

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- $ 8

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$ 117

8.61

- $ 8

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$ 117

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- $ 8

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$ 117

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- $ 8

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$ 117

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- $ 8

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$ 114

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- $ 8

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$ 112

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- $ 8

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$ 177

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- $ 1

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$ 125

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- $ 9

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$ 125

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- $ 9

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$ 144

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- $ 1

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$ 129

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- $ 9

73.4

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$ 129

7.95

- $ 9

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$ 129

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- $ 9

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$ 182

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- $ 1

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$ 187

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$ 670

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- $ 5

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$ 861

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- $ 6

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$ 697

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$ 523

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$ 178

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- $ 1

337.

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$ 966

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$ 724

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$ 966

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$ 724

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2018 MEDICARE REIMBURSEMENT SCHEDULE FOR STANDARD & CUSTOM STYLES

The Medicare L Code floor and ceiling allowables reflect the variance by state. The reimbursement rates listed are for reference only.

The Standard, Tall, Unweighting, Extended and Partial Foot AFOs have been reviewed by Medicare and the L codes listed are what are suggested. The other product styles have not been reviewed and the final and sole responsibility for the correct coding, within established laws, rules and standards of practice, rest upon the party submitting the claim.

*L2210 may be used on articulated styles that utilize dorsi-flexion assist joint.

110117_ArizonaAFO-Quick Reference Guide.indd 1 1/15/2018 9:36:38 AM

ARIZONA AFO QUICK REFERENCE GUIDE

ARIZONA STANDARD BRACE®

Clinical Indications:• PTTD (Posterior Tibial Tendon Dysfunction)• Talocalcaneal varus or valgus• Tibialis tendonitis (posterior or anterior)• Severe pronation or pes planus• Ankle arthritis or Degenerative Joint Disease (DJD)• Charcot foot• Ankle, subtalar or midtarsal trauma• Chronic Achilles tendonitis

Suggested L Codes: L1940, L2330, L2820

ARIZONA BRACE® - TALLClinical Indications:• PTTD (Posterior Tibial Tendon Dysfunction)• Talocalcaneal varus or valgus• Tibialis tendonitis (posterior or anterior)• Severe pronation or pes planus• Ankle arthritis or Degenerative Joint Disease (DJD)• Charcot foot• Ankle, subtalar or midtarsal trauma• Chronic Achilles tendonitis


ARIZONA BRACE® - EXTENDEDClinical Indications:• Post fractures of the distal tibia• Post fractures of the ankle, subtalar

and midtarsal trauma• Charcot foot• Severe ankle instability• Post fractures of the distal tibia


ARIZONA BRACE® - UNWEIGHTINGClinical Indications:• Post fractures of the distal tibia• Post fractures of the ankle, subtalar

and midtarsal trauma• Following reconstructive orthopedic surgery

after crushing injuries to the midfoot and hindfoot• Ankle arthritis or Degenerative Joint Disease (DJD)• Charcot foot• Severe ankle instability•


ARIZONA BRACE® - ARTICULATEDClinical Indications:• Mild Posterior Tibial Tendon Dysfunction (PTTD)• Mild to moderate Degenerative Joint Disease (DJD)• Talocalcaneal varus or valgus• Ankle instability• Mild to moderate pronation• Charcot foot• Paralytic equinus or drop foot• Trauma


AZ SPORTYTM

Clinical Indications:• Sports injuries, such as chronic ankle sprains• Less severe conditions that do not require support

for the medial longitudinal arch


AZ BREEZETM

Clinical Indications:• Posterior Tibial Tendon Dysfunction (PTTD)• Talocalcaneal varus or valgus• Tibialis tendonitis (posterior or anterior)• Severe pronation or pes planus• Ankle arthritis or Degenerative Joint Disease (DJD)• Charcot foot• Ankle, subtalar or midtarsal trauma• Chronic Achilles tendonitis


AZ SLIMTM

Clinical Indications:• Ankle instability (Note: No plastic inner shell, all leather gauntlet)


MOORE BALANCE BRACE (MBB)TM

Clinical Indications:• Difficulty walking and/or maintaining balance • Chronic ankle Instability • Arthritic ankle


ARIZONA MEZZOTM

Clinical Indications:• Posterior Tibial Tendon Dysfunction (PTTD) Stages 1 & 2• Sinus Tarsi Syndrome• Hypotonia/low tone• Peroneal tendonitis• Plantar fasciitis• Ankle, subtalar or midtarsal trauma• Osteoarthritis of the subtalar and midtarsal joints

Suggested L Codes: L1907, L2330

EC NEUROWALKERTM

Clinical Indications:• Charcot foot and ankle• Post fractures of the distal tibia• Neuropathic conditions of the ankle and foot • Severe ankle instability

Suggested L Codes: L1960, L2330, L2820, L3400

PARTIAL FOOT AFOTM

Clinical Indications:• Trans-metatarsal amputation• Chopart’s amputations• Syme’s amputations


PARTIAL FOOT WALKERTM

Clinical Indications:Abnormally sized and/or shaped feet and ankles in conjunction with the indications listed for the Standard and Tall Arizona Brace®.• Trans-metatarsal amputations• Chopart’s amputation• Syme’s amputation

Suggested L Codes: L1960, L2330, L2820, L5000, L3400

CLOSED TOE WALKERTM

Clinical Indications:Abnormally sized and/or shaped feet and ankles in conjunction with the indications listed for the Standard and Tall Arizona Brace®.• Posterior Tibial Tendon Dysfunction (PTTD)• Talocalcaneal vargus or valgus• Tibial tendonitis• Severe pronation or pes planus• Ankle arthritis or Degenerative Joint Disorder (DJD)• Charcot foot• Chronic Achilles tendonitis• Ankle, subtalar or midtarsal trauma


OPEN TOE WALKERTM

Clinical Indications:• Foot drop• Arthritic abnormalities• Ankle arthritis or Degenerative

Joint Disease (DJD)• Abnormal foot shapes


ARIZONA OPTIMA BRACETM

Clinical Indications:• Mild to moderate Posterior

Tibial Tendon Dysfunction (PTTD) • Chronic ankle instability


SPLIT UPRIGHTClinical Indications:• Posterior Tibial Tendon

Dysfunction (PTTD)• Lateral & medial instability

of subtalar joint• Chronic ankle instability • Severe pronation• Sinus tarsi syndrome• Trauma


THERMOPLASTIC AFOClinical Indications:• Foot drop• Weak or absent plantar flexors

and/or dorsiflexors• Severe degenerative arthritis• Severe pronation or pes planus• Lateral and medial instability

of subtalar joint• Trauma

Suggested L Codes: L1960

THERMOPLASTIC AFO - ARTICULATEDClinical Indications:• Mild Posterior Tibial Tendon

Dysfunction (PTTD)• Mild degenerative arthritis• Lateral and medial instability

of subtalar joint• Foot drop• Severe pronation• Trauma Suggested L Codes: L1970

SUPRA MALLEOLAR ORTHOSIS - SMOClinical Indications:• Arthritic conditions• Charcot foot• Chronic ankle sprains• Instability• Posterior tibial weakness or rupture• Low tone, hypotonic patient

Suggested L Code: L1907

AZ CROW WALKERTM

Clinical Indications:

• Charcot foot

Suggested L Code: L4631

Sand Black White Brown Pink Sand Black White Brown Pink

Sand Black White Brown Pink

Sand Black White Brown Pink Sand Black White Brown Pink


Sand Black

Sand Black White Brown PinkSand Black

Sand Black White Brown






Black

Black Black WhiteBlack White

Black White

Black Natural

SPECIALITY COLLECTIONTHERM

OPLASTIC COLLECTIONGAUNTLET AFO COLLECTION

TM

www.arizonaafo.comT: 877.780.8382 F: 480.222.1599

110117_ArizonaAFO-Quick Reference Guide.indd 2 1/15/2018 9:37:17 AM

2018 medicare reimbursement schedule the medicare...

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