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CPT® K0902-RTKX - 1 Units tagged for the DX M13.161, M13.162, Still Medicare denied for the Medically not necessary. Even i dont find any LCD coverage. Can you please me to fix this
re: CPT® K0902
K0902 IS FOR : Prefabricated knee orthoses (KO) are ready-made (prefabricated) knee braces that are purchased off-the-shelf with no custom fitting or adjustment. Report K0901 for a single upright hinge and K0902 for a double upright hinge. Both are secured to the leg at the thigh and calf, have adjustable flexion and extension joint (unicentric or polycentric), and medial-lateral and rotation control, with or without varus/valgus adjustment.
M13.161: Monoarthritis, not elsewhere classified, right knee, M13.162 :
Monoarthritis, not elsewhere classified, left knee
_Basically your putting one brace on the claim for both the RT and LT knee, no modifiers should be on K0902.
A knee immobilizer without joints (L1830), or a knee orthosis with adjustable knee joints (L1832, L1833), or a knee orthosis, with an adjustable flexion and extension joint that provides both medial-lateral and rotation control (K0901, K0902, L1843, L1845), are covered if the beneficiary has had recent injury to or a surgical procedure on the knee(s). Refer to the diagnoses listed in the Diagnosis Codes That Support Medical Necessity Groups 2 or 4 Code sections.
For codes K0901, K0902, L1832, L1833, L1843, L1845 and L1850, knee instability must be documented by examination of the beneficiary and objective description of joint laxity (e.g., varus/valgus instability, anterior/posterior Drawer test).
SUPERSEDED Local Coverage Determination (LCD):
Knee Orthoses (L33318)
re: CPT® K0902