AFO and KAFO Custom Fabricated versus Prefabricated Codes - RAC Identified Issue
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AFO and KAFO Custom Fabricated versus Prefabricated Codes - RAC Identified Issue

HCPCS codes for Ankle Foot Orthotic and Knee Ankle Foot additions that include the descriptors "For Custom Fabricated Orthosis Only" or "Molded to Patient Model" may not be billed with HCPCS codes for prefabricated base orthotics.  These addition codes, when paid for on the same date of service and for the same extremity as the prefabricated base orthotic codes, are overpayments.  This article is a result of findings from the Recovery Audit Contractor (RAC), HealthDataInsights, as published as "New Issues Approved by CMS."

Resources pertaining to this RAC identified issue:

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