K0901 – Knee orthosis (ko), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf
HCPCS Level II code · K codes: Temporary Codes for DME
HCPCS codeK0901
- Long description
- Knee orthosis (ko), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf
- Short description
- Ko single upright pre ots
- Pricing indicator
38Orthotics, prosthetics, prosthetic devices & vision services- Medicare coverage
CCarrier judgment – coverage decided by the Medicare contractor- BETOS category
D1FProsthetic/Orthotic devices- Cross reference
- L1851
- Added
- October 1, 2014
- Last change
- January 1, 2017 – No change
- Termination date
- December 31, 2016
Frequently asked questions
What is HCPCS code K0901?
K0901 is a HCPCS Level II code for knee orthosis (ko), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf. It was discontinued on December 31, 2016.
Does Medicare cover K0901?
The HCPCS file lists coverage code C: Carrier judgment – coverage decided by the Medicare contractor. Coverage and payment also depend on local coverage determinations and the patient’s plan.
Nearby K codes
- K0884 – Power wheelchair, group 4 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
- K0885 – Power wheelchair, group 4 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds
- K0886 – Power wheelchair, group 4 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
- K0890 – Power wheelchair, group 5 pediatric, single power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds
- K0891 – Power wheelchair, group 5 pediatric, multiple power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds
- K0898 – Power wheelchair, not otherwise classified
- K0899 – Power mobility device, not coded by dme pdac or does not meet criteria
- K0900 – Customized durable medical equipment, other than wheelchair
- K0902 – Knee orthosis (ko), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf
- K0903 – For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each
- K1001 – Electronic positional obstructive sleep apnea treatment, with sensor, includes all components and accessories, any type
- K1002 – Cranial electrotherapy stimulation (ces) system, any type
- K1003 – Whirlpool tub, walk-in, portable
- K1004 – Low frequency ultrasonic diathermy treatment device for home use
- K1005 – Disposable collection and storage bag for breast milk, any size, any type, each
- K1006 – Suction pump, home model, portable or stationary, electric, any type, for use with external urine management system
Source: CMS HCPCS Level II quarterly file, October 2026. Reference only – check payer policy before billing.