2025 HCPCS code L1990
Ankle foot orthosis (AFO), double upright, free plantar/dorsiflexion, solid stirrup, calf band/cuff (double bar 'BK' orthosis), custom fabricated.
Modifiers may be applicable to indicate specific aspects of the service, such as left or right side (LT, RT) or purchase/rental options.
Medical necessity for an AFO is established when it is required to address a medical condition that impairs mobility and function. The AFO should be expected to provide a functional benefit and improve the patient's quality of life.
Prescribed and fitted by a healthcare professional specializing in orthotics, such as an orthotist or prosthetist. They are responsible for ensuring proper fit, function, and patient education.
In simple words: This is a custom-made brace for the ankle and foot. It has two supports that go up the calf and allow the foot to move up and down. It's made to fit the patient specifically.
This code represents a custom-fabricated ankle-foot orthosis (AFO) with double uprights, allowing free plantar and dorsiflexion, and featuring a solid stirrup and a calf band/cuff. It's also known as a double bar BK orthosis.
Example 1: A patient with drop foot following a stroke requires an AFO to improve gait and stability., A child with cerebral palsy needs an AFO to help control spasticity and improve mobility., An athlete with a severe ankle sprain uses an AFO for support and to prevent re-injury during rehabilitation.
Documentation should include the diagnosis necessitating the AFO, the patient's functional limitations, the type of AFO provided (L1990), and the expected functional benefit. Justification for custom fabrication should be clearly documented.
- Payment Status: Covered
- Specialties:Orthotics and Prosthetics, Physical Medicine and Rehabilitation, Orthopedic Surgery, Neurology, Pediatrics
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital (if fitted during an inpatient stay)