L1904 – Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated

Long description

Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated

Short description

Afo molded ankle gauntlet

Pricing indicator

38 Orthotics, prosthetics, prosthetic devices & vision services

Medicare coverage

C Carrier judgment – coverage decided by the Medicare contractor

BETOS category

D1F Prosthetic/Orthotic devices

Added

January 1, 1988

Last change

January 1, 2016 – No change

Nearby L codes

• L1847 – Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
• L1848 – Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated, off-the-shelf
• L1850 – Knee orthosis, swedish type, prefabricated, off-the-shelf
• L1851 – 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
• L1852 – 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
• L1860 – Knee orthosis, modification of supracondylar prosthetic socket, custom fabricated (sk)
• L1900 – Ankle foot orthosis, spring wire, dorsiflexion assist calf band, custom fabricated
• L1902 – Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf
• L1906 – Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf
• L1907 – Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated
• L1910 – Ankle foot orthosis, posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment
• L1920 – Ankle foot orthosis, single upright with static or adjustable stop (phelps or perlstein type), custom fabricated
• L1930 – Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment
• L1932 – Ankle foot orthosis, rigid anterior tibial section, total carbon fiber or equal material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
• L1933 – Ankle foot orthosis, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, off-the-shelf
• L1940 – Ankle foot orthosis, plastic or other material, custom fabricated