DME Bundles L1846 custom brace

I have had two different insurance companies deny L2275 (interface liner), L2830 (above knee addition to orthosis), and L2820 (below knee addition to orthosis), stating it is bundled to custom brace L1846, but our coder states these are separately billed items, whose right?

re: DME Bundles L1846 custom brace

I checked the LCD for Noridian please see below:

Addition codes will be denied as not reasonable and necessary if the base orthosis is not reasonable and necessary or the addition is not reasonable and necessary.

Base Code Addition Codes - Eligible for Separate Payment

L1834 L2795

L1840 L2385, L2390, L2395, L2397, L2405, L2415, L2425, L2430, L2492, L2755, L2785, L2795

L1844 L2385, L2390, L2395, L2397, L2405, L2492, L2755, L2785

L1846 L2385, L2390, L2395, L2397, L2405, L2415, L2492, L2755, L2785, L2795, L2800

L1860 None


The following table lists addition codes which describe components or features that can be physically incorporated in the specified custom fabricated base orthosis but are considered not reasonable and necessary. These addition codes, if they are billed with the related base code, will be denied as not reasonable and necessary.

Base Code Addition Codes - Not Reasonable and Necessary

L1834 L2397, L2800

L1840 L2275, L2800

L1844 None

L1846 None

L1860 L2397

re: DME Bundles L1846 custom brace

Thank you very much, this helps a lot.

re: DME Bundles L1846 custom brace

Either a nonremovable soft interface (L2820, L2830) or two (2) removable soft interfaces (K0672) are included in the allowance for a knee orthosis. Soft interfaces billed separately at the time of initial issue will be denied as not separately payable.