2025 HCPCS code L1980

Supply of a custom-fabricated ankle-foot orthosis (AFO) with a single upright bar, allowing for plantar flexion and dorsiflexion.

Follow current HCPCS coding guidelines and payer-specific instructions for appropriate billing and documentation requirements.Ensure that the documentation clearly supports the medical necessity of the custom-fabricated AFO and that all required information is included on the claim.

Modifiers may be applicable depending on the circumstances of service.Consult the most current modifier guidelines.

Medical necessity for a custom-fabricated AFO (L1980) must be established based on the patient's specific medical condition and functional limitations.Documentation should clearly demonstrate the need for a custom device, as opposed to a prefabricated AFO, to address the patient's individual needs.Factors to consider include severity of the condition, the patient's anatomy, and the specific functional requirements of the device.Refer to payer-specific policies for additional medical necessity criteria.

The clinical responsibility lies with the physician who orders and prescribes the custom AFO, ensuring the appropriateness of the device for the patient's specific needs and condition. The orthotist is responsible for the fabrication and fitting of the device.

IMPORTANT L1990 (AFO with double upright bar) may be appropriate for patients requiring a different level of support.Refer to physician documentation for specific device requirements.

In simple words: This code covers the cost of a custom-made ankle brace. The brace supports the ankle and foot, allowing for normal movement up and down. It's made specifically to fit one person.

This HCPCS code represents the supply of a custom-fabricated ankle-foot orthosis (AFO).The AFO features a single upright bar extending along the length of the calf, a solid stirrup, and a calf band or cuff. This design allows for free plantar flexion and dorsiflexion of the foot. The orthosis is specifically manufactured to fit the individual patient's needs.

Example 1: A patient with a foot drop due to nerve damage requires a custom AFO to improve gait and prevent falls. Code L1980 would be used to bill for the supply of the custom-made AFO., A patient recovering from an ankle fracture needs an AFO to provide support and stability during rehabilitation.L1980 would bill for the custom-fabricated AFO specific to their needs., A patient with cerebral palsy requires an AFO to improve their walking ability and to reduce deformity. L1980 would be appropriate for the custom-fabricated AFO required to address the patient's unique needs.

* Physician's order specifying the need for a custom-fabricated AFO.* Detailed documentation of the patient's condition, including medical necessity for the device.* Measurements and specifications of the custom-made AFO.* Documentation of the fitting and adjustment of the AFO.

** Always refer to the most up-to-date HCPCS codebook and payer-specific guidelines for complete and accurate billing practices.The information provided here is for informational purposes only and should not be considered a substitute for professional medical coding advice.

  • Payment Status: Active
  • Modifier TC rule: Not applicable.
  • Specialties:Orthopedics, Physical Medicine and Rehabilitation, Podiatry
  • Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center
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