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Charcot Restraint Orthotic Walker - CROW Boot - Coding
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Charcot Restraint Orthotic Walker - CROW Boot - Coding

The Charcot Restraint Orthotic Walker also referred to as CROW boot or walker, was developed for patients with severe deformity of the foot and ankle due to a sensory neuropathic arthropathy - most commonly caused by diabetes.

The device is a bi-valved copolymer full foot enclosure, totally encapsulated around the ankle and foot with a rocker bottom sole built into the device.  The orthosis is custom fabricated to a positive model made from an impression of the patient's affected limb.  It is fully lined and uses a custom foot insert.  Appropriate modifications are performed to the impression, which permits for equal weight distribution through the limb and provides support of the ankle joint, tibia, and fibula.  The CROW boot can be modified to accommodate changes by flaring, adding padding, and trimming where and when appropriate.

A CROW boot is billed using the following codes:

L1960 ANKLE FOOT ORTHOSIS, POSTERIOR SOLID ANKLE, PLASTIC, CUSTOM-FABRICATED

L2232 ADDITION TO LOWER EXTREMITY ORTHOSIS, ROCKER BOTTOM FOR TOTAL CONTACT ANKLE FOOTORTHOSIS, FOR CUSTOM FABRICATED ORTHOSIS ONLY

L2275 ADDITION TO LOWER EXTREMITY, VARUS/VALGUS CORRECTION, PLASTIC MODIFICATION, PADDED/LINED

L2340 ADDITION TO LOWER EXTREMITY, PRE-TIBIAL SHELL, MOLDED TO PATIENT MODEL

L2820 ADDITION TO LOWER EXTREMITY ORTHOSIS, SOFT INTERFACE FOR MOLDED PLASTIC, BELOW KNEE SECTION

L3010 FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, LONGITUDINAL ARCH SUPPORT, EACH

No other codes may be billed for a CROW boot.  There is no separate billing for any modifications, fitting, or adjustments.

When these products are used solely to treat edema or ulcers or to prevent an ulcer of the lower extremity, suppliers should code them based on the patient's condition.  HCPCS code A9283 (Foot pressure off loading/ supportive device, any type, each) was developed to describe various devices used for the treatment of edema or for a lower extremity ulcer or for the prevention of ulcers.  If the CROW boot is used for these conditions and the patient does not have Charcot arthropathy, then it should be coded A9283.

Suppliers should contact the Pricing, Data Analysis, and Coding contractor (PDAC) for guidance on the correct coding of specific items.