Knees

Knee Orthosis (AFO)

Coverage Determination:

  • Treatment of Non-fixed Knee Joint Contractures
  • Stablize Knee Extension
  • Knee Joint Immobilization
  • Increasing Range of Motion

SoftPro Static Knee - OrthoPro ROM Knee - OrthoPro Stablizer Knee - DynaPro Flex Knee - DynaPro ROM Knee - AirPro COKO Knee - OrthoPro OA Knee Brace

SoftPro Static Knee

  • Product Description: Static Knee Orthosis
  • Product Treats: Knee flexion contracture
  • Product Utilization: Patient has pain along with decreased ROM and expectations are progressive extension in conjuction with passive ROM therapy. This is defined as ROM provided by caregiver. This brace is for a non-ambulatory patient.
  • Sizes: RT/LT/Bilateral small, medium, large based on measurements of upper and lower leg circumference. Approximately 4 inches above and below the knee joint.
  • Coding: L1831 Knee Orthosis with locking joint, ICD Code 718.46 Contracture of lower leg joint
  • Required Documentation: Therapy, Nursing or Physician notes stating the patient has the above diagnosis and requires a static KO for treatment of knee contracture. Telephone order is required for dispensing and must state RT/LT/ Bilateral KO for treatment of contracture. Must also include addition of gel knee cap for three point leverage.
  • Adjunct Products: Gel Knee Pad. Must be ordered separately for third point of leverage. Must also be listed on the DME form as L2795 Knee control full knee cap.

OrthoPro ROM Knee

  • Product Description: ROM Knee Orthosis
  • Product Treats: See conditions listed below
  • Product Utilization: Patient is weight bearing and requires assitance with ambulation. The ROM hinge allows for control of extension and flexion with ROM. The expectation is extension through ROM while controlling flexion contracture.
  • Sizes: RT/LT/Bilateral small, medium, large based on measurements of upper and lower leg circumference. Approximately 4 inches above and below the knee joint.
  • Coding: L1832 Knee Orthosis with adjustable joint and rigid support
  • Required Documentation:Therapy, Nursing or Physician notes stating the patient has had a recent injury to or surgical procedure on the knee; and
    1. The patient requires a brace with range of motion limitations; and
    2. The patient has one of the following diagnoses:
      Rheumatoid arthritis (ICD-9 code 714.0 – 714.4)
      Osteoarthritis (715.16, 715.26, 715.36, 715.96)
      Meniscal cartilage derangement (717.0 – 717.5)
      Chondromalacia of patella (717.7)
      Knee ligamentous disruption (717.81 – 717.9)
      Rupture of tendon, nontraumatic - quadriceps tendon (727.65)
      Pathologic fracture of femur (733.15)
      Pathologic fracture of tibia or fibula (733.16)
      Aseptic necrosis of tibia or fibula (733.49)
      Stress fracture of tibia or fibula (733.93)
      Congenital deformity of knee (755.64)
      Fracture of femur - lower end (821.20 – 821.39)
      Fracture of patella (822.0, 822.1)
      Fracture of tibia and/or fibula - upper end (823.00 – 823.42)
      Dislocation of knee (836.0 – 836.69)
      Failed total knee arthroplasty (996.4, 996.66, 996.77, V43.65
    Telephone order is required for dispensing and must state RT/LT/ Bilateral KO for treatment and to provide support for ambulation. Must also include addition of gel knee cap for three point leverage.
  • Adjunct Products: Gel Knee Pad. Must be ordered separately for third point of leverage. Must also be listed on the DME form as L2795 Knee control full knee cap.

OrthoPro Stablizer Knee

  • Product Description: ROM Knee Orthosis
  • Product Treats: See conditions listed below
  • Product Utilization: Patient is weight bearing and requires for assitance with ambulation. The ROM hinge allows for control of extension and flexion with ROM. The expectation is extension through ROM while controlling flexion contracture.
  • Sizes: RT/LT/Bilateral small, medium, large based on measurements of upper and lower leg circumference. Approximately 4 inches above and below the knee joint.
  • Coding: L1832 Knee Orthosis with adjustable joint and rigid support
  • Required Documentation:Therapy, Nursing or Physician notes stating the patient has had a recent injury to or surgical procedure on the knee; and
    1. The patient requires a brace with range of motion limitations; and
    2. The patient has one of the following diagnoses:
      Rheumatoid arthritis (ICD-9 code 714.0 – 714.4)
      Osteoarthritis (715.16, 715.26, 715.36, 715.96)
      Meniscal cartilage derangement (717.0 – 717.5)
      Chondromalacia of patella (717.7)
      Knee ligamentous disruption (717.81 – 717.9)
      Rupture of tendon, nontraumatic - quadriceps tendon (727.65)
      Pathologic fracture of femur (733.15)
      Pathologic fracture of tibia or fibula (733.16)
      Aseptic necrosis of tibia or fibula (733.49)
      Stress fracture of tibia or fibula (733.93)
      Congenital deformity of knee (755.64)
      Fracture of femur - lower end (821.20 – 821.39)
      Fracture of patella (822.0, 822.1)
      Fracture of tibia and/or fibula - upper end (823.00 – 823.42)
      Dislocation of knee (836.0 – 836.69)
      Failed total knee arthroplasty (996.4, 996.66, 996.77, V43.65
    Telephone order is required for dispensing and must state RT/LT/ Bilateral KO for treatment and to provide support for ambulation. Must also include addition of gel knee cap for three point leverage.
  • Adjunct Products: None

DynaPro Flex Knee

  • Product Description: Static Flex Neuro-Dynamic Therapy
  • Product Treats: Knee flexion contracture
  • Product Utilization: Treats mild to moderate flexion contractures. Provides low load prolonged stretch and accomodates non-voluntary muscle contractions. Non-ambulatory knee brace
  • Sizes: RT/LT/Bilateral small, medium, large based on measurements of upper and lower leg circumference. Approximately 4 inches above and below the knee joint.
  • Coding: L1831 Knee Orthosis with pos locking joint, ICD Code 718.46 Contracture of lower leg joint
  • Required Documentation: Therapy, Nursing or Physician notes stating the patient has the above diagnosis and requires a KO with LLPS for treatment of knee contracture. Telephone order is required for dispensing and must state RT/LT/Bilateral KO for treatment of contracture.
  • Adjunct Products: Gel Knee Pad is included with the product.

DynaPro ROM Knee

  • Product Description: ROM Knee Orthosis
  • Product Treats: See conditions listed below
  • Product Utilization: Patient is weight bearing and requires for assitance with ambulation. The ROM hinge allows for control of extension and flexion with ROM. The expectation is extension through ROM while controlling flexion contracture.
  • Sizes: RT/LT/Bilateral small, medium, large based on measurements of upper and lower leg circumference. Approximately 4 inches above and below the knee joint.
  • Coding: L1832 Knee Orthosis with adjustable joint and rigid support
  • Required Documentation:Therapy, Nursing or Physician notes stating the patient has had a recent injury to or surgical procedure on the knee; and
    1. The patient requires a brace with range of motion limitations; and
    2. The patient has one of the following diagnoses:
      Rheumatoid arthritis (ICD-9 code 714.0 – 714.4)
      Osteoarthritis (715.16, 715.26, 715.36, 715.96)
      Meniscal cartilage derangement (717.0 – 717.5)
      Chondromalacia of patella (717.7)
      Knee ligamentous disruption (717.81 – 717.9)
      Rupture of tendon, nontraumatic - quadriceps tendon (727.65)
      Pathologic fracture of femur (733.15)
      Pathologic fracture of tibia or fibula (733.16)
      Aseptic necrosis of tibia or fibula (733.49)
      Stress fracture of tibia or fibula (733.93)
      Congenital deformity of knee (755.64)
      Fracture of femur - lower end (821.20 – 821.39)
      Fracture of patella (822.0, 822.1)
      Fracture of tibia and/or fibula - upper end (823.00 – 823.42)
      Dislocation of knee (836.0 – 836.69)
      Failed total knee arthroplasty (996.4, 996.66, 996.77, V43.65
    Telephone order is required for dispensing and must state RT/LT/ Bilateral KO for treatment and to provide support for ambulation. Must also include addition of gel knee cap for three point leverage.
  • Adjunct Products: Gel Knee Cap included with order.

AirPro COKO Knee

  • Product Description: Air Knee Orthosis
  • Product Treats: Knee flexion contracture
  • Product Utilization: Gently reverses tissue shortening with air bladder therapy for non-ambulatory patient. Removable quickset hinge allow the product to be used with air only on a severe contracture and then progress to a ROM hinge. This product is optimal for a patient with pain and/or poor skin integrity.
  • Sizes: RT/LT/Bilateral small, medium, large based on measurements of upper and lower leg circumference. Approximately 4 inches above and below the knee joint.
  • Coding: L1831 Knee Orthosis with adjustable air chambers. ICD Code 718.46 Contracture of lower leg joint
  • Required Documentation: Therapy, Nursing or Physician notes stating the patient has the above diagnosis and requires a KO for treatment of knee contracture. Telephone order is required for dispensing and must state RT/LT/Bilateral KO for treatment of contracture. Knee pad for three point leverage
  • Adjunct Products: Gel Knee Pad must be ordered for three point leverage. There is no additional billing for the knee cap with the COKO Knee.

OrthoPro OA Knee Brace

  • Product Description: Osteoarthritis Knee Brace
  • Product Treats: OA of Knee
  • Product Utilization: Treats uni-compartmental osteoarthritis of knee, unloads pressure off of knee, functionally corrects abnormal gait and reduces knee pain
  • Sizes: RT/LT/Bilateral small, medium, large, x-large, xx-large, xxx-large based on measurements of upper and lower leg circumference. Approximately 4 inches above and below the knee joint.
  • Coding: L1845 KO with adjustable flexion/extension rotation
  • Multiple sclerosis (ICD-9 code 340)
    Hemiplegia, unspecified (342.9)
    Infantile cerebral palsy, unspecified (343.9)
    Paraplegia of both lower limbs (344.1)
    Mononeuritis of lower limb, unspecified (355.0, 355.2)
  • Rheumatoid arthritis (ICD-9 code 714.0 – 714.4)
    Osteoarthritis (715.16, 715.26, 715.36, 715.96)
    Meniscal cartilage derangement (717.0 – 717.5)
    Chondromalacia of patella (717.7)
    Knee ligamentous disruption (717.81 – 717.9)
    Rupture of tendon, nontraumatic - quadriceps tendon (727.65)
    Pathologic fracture of femur (733.15)
    Pathologic fracture of tibia or fibula (733.16)
    Aseptic necrosis of tibia or fibula (733.49)
    Stress fracture of tibia or fibula (733.93)
    Congenital deformity of knee (755.64)
    Fracture of femur - lower end (821.20 – 821.39)
    Fracture of patella (822.0, 822.1)
    Fracture of tibia and/or fibula - upper end (823.00 – 823.42)
    Dislocation of knee (836.0 – 836.69)
    Failed total knee arthroplasty (996.4, 996.66, 996.77, V43.65
  • Required Documentation: Therapy, Nursing or Physician notes stating the patient has the above diagnosis and requires a KO for ambulation. Telephone order is required for dispensing and must state RT/LT/ Bilateral.
  • Adjunct Products: None

NeuroFlex Restorative Knee - RestAir Knee

NeuroFlex Restorative Knee

  • Product Description: Air Knee Orthosis
  • Product Treats: Knee flexion contracture
  • Product Utilization: Gently reverses tissue shortening with air bladder therapy for non-ambulatory patient. This product is optimal for a patient with pain and or poor skin integrity.
  • Sizes: RT/LT/Bilateral small, medium, large based on measurements of upper and lower leg circumference. Approximately 4 inches above and below the knee joint.
  • Coding: L1831 Knee Orthosis with adjustable air chamber. ICD Code 718.46 Contracture of lower leg joint
  • Required Documentation: Therapy, Nursing or Physician notes stating the patient has the above diagnosis and requires a KO for treatment of knee contracture. Telephone order is required for dispensing and must state RT/LT/Bilateral KO for treatment of contracture. Knee pad for three point leverage.
  • Adjunct Products: Gel Knee Pad is included for three point leverage.

Ranger Knee (L1832 OR L1831) - Ranger "EZ" Lock Knee (L1831) - Care Rest Knee (L1831) - Ranger Air Knee (L1847) - Care Bendable Knee

Ranger Knee (L1832 OR L1831)

  • Knee orthosis with adjustable locking knee joints. Provides progressive treatment/correction of mildly to severe knee flexion contractures. Patented joint allows for simple adjustment in 10 degree increments.

Ranger "EZ" Lock Knee (L1831)

  • The Ranger E-Z Knee is the “easiest-to-set” static lock hinge on the market
  • The Ranger E-Z Knee has a double upright metal hinged knee brace designed to provide progressive treatment and correction of knee flexion contractures in “non-ambulatory” patients.

Care Rest Knee

  • Extremely light weight, provides progressive treatment of knee flexion contractures. Adjustable locking knee joint. Light to medium duty, Non ambulatory. Available in to sizes (S, Uni)

Ranger Air Knee (L1847)

  • Treats knee flexion contractures with postier air bladders, and fully adjustable knee hinges. Available in 3 sizes (S,M,L)

Care Bendable Knee

  • Easy to use bendable orthosis used for gradual extension of non-fixed contractures. Great as a resting splint, stabilizing, or for wound care positioning.