Local Coverage Determinations and their HCPCS Codes
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Local Coverage Determinations and their HCPCS Codes

The following table outlines the current LCDs that a pedorthist would utilize, along with the HCPCS addressed in each LCD and a brief description of the LCD. Each LCD has a corresponding policy article that contains additional coding and coverage information. To access all of the current LCDs from each DME MAC, along with the corresponding policy article and other resources, visit the PFA website at http://www.pedorthics.org/InformationforDMEPOSSuppliers/CurrentDMEMACLCDsPolicyArticlesandMore/tabid/248/Default.aspx.






Ankle-Foot/Knee-Ankle-Foot Orthosis


A9283, L1900, L1901, L1902, L1904, L1906, L1907, L1910, L1920, L1930, L1940, L1945, L1950, L1951, L1960, L1970, L1971, L1980, L1990, L2000, L2005, L2010, L2020, L2030, L2034, L2035, L2036, L2037, L2038, L2106, L2108, L2112, L2114, L2116, L2126, L2128, L2132, L2134, L2136, L2180, L2182, L2184, L2186, L2188, L2190, L2192, L2200, L2210, L2220, L2230, L2232, L2240, L2250, L2260, L2265, L2270, L2275, L2280, L2300, L2310, L2320, L2330, L2335, L2340, L2350, L2360, L2370, L2375, L2380, L2385, L2387, L2390, L2395, L2397, L2405, L2415, L2425, L2430, L2492, L2500, L2510, L2520, L2525, L2526, L2530, L2540, L2550, L2750, L2755, L2760, L2768, L2770, L2780, L2785, L2795, L2800, L2810, L2820, L2830, L2840, L2850, L2999, L4002, L4010, L4020, L4030, L4040, L4045, L4050, L4055, L4060, L4070, L4080, L4090, L4100, L4110, L4130, L4205, L4210, L4350, L4360, L4370, L4386, L4392, L4394, L4396, L4398

The purpose of a brace is to support a weak or deformed body member or to restrict or eliminate motion in a diseased or injured part of the body. The AF/KAF orthoses policy addresses the medical necessity requirements for coverage and payment of these items.

Orthopedic Footwear


A9283, L3000, L3001, L3002, L3003, L3010, L3020, L3030, L3031, L3040, L3050, L3060, L3070, L3080, L3090, L3100, L3140, L3150, L3160, L3170, L3201, L3202, L3203, L3204, L3206, L3207, L3208, L3209, L3211, L3212, L3213, L3214, L3215, L3216, L3217, L3219, L3221, L3222, L3224, L3225, L3230, L3250, L3251, L3252, L3253, L3254, L3255, L3257, L3260, L3265, L3300, L3310, L3320, L3332, L3334, L3340, L3350, L3360, L3370, L3380, L3390, L3400, L3410, L3420, L3430, L3440, L3450, L3455, L3460, L3465, L3470, L3480, L3485, L3500, L3510, L3520, L3530, L3540, L3550, L3560, L3570, L3580, L3590, L3595, L3600, L3610, L3620, L3630, L3640, L3649

Orthopedic footwear are an integral part of a covered leg brace. The LCD provides the indications and limitation of coverage and the documentation guidelines.

Therapeutic Shoes for Persons with Diabetes


A5500, A5501, A5503, A5504, A5505, A5506, A5507, A5508, A5510, A5512, A5513

The indications and limitations of coverage and documentation guidelines for therapeutic shoes are located in the LCD.


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