L1681 Prefabricated Bilateral Hip Abduction Orthosis - Correct Coding

Joint DME MAC and PDAC Publication

As part of the first biannual (B1) 2023 HCPCS coding cycle, the Centers for Medicare & Medicaid Services established a new HCPCS code, L1681 (HIP ORTHOSIS, BILATERAL HIP JOINTS AND THIGH CUFFS, ADJUSTABLE FLEXION, EXTENSION, ABDUCTION CONTROL OF HIP JOINT, POSTOPERATIVE HIP ABDUCTION TYPE, PREFABRICATED ITEM THAT HAS BEEN TRIMMED, BENT, MOLDED, ASSEMBLED, OR OTHERWISE CUSTOMIZED TO FIT A SPECIFIC PATIENT BY AN INDIVIDUAL WITH EXPERTISE) effective for dates of service on or after October 1, 2023. The DME MACs and the Pricing, Data Analysis and Coding (PDAC) Contractor are providing this article to educate suppliers to correctly code products which are described by this L-code.

L1681 describes a prefabricated orthosis with a semirigid, or rigid waist band connected to bilateral rigid uprights that includes a hip joint and a rigid thigh cuff. Both hip joints provide adjustable for extension/flexion as well as abduction; the hip joint aligns and maintains the femur in an abducted position. This orthosis is typically used in the post-operative setting. L1681 is a complete product, as it is inherent in the definition of "prefabricated" that a particular item is complete. Custom-fabricated additions will be denied as incorrect coding if billed with the L1681 prefabricated orthosis, since custom fabricated additions are only appropriate for custom-fabricated base orthotics.

L1681 includes fitting and adjustment at the time of delivery. Devices that are prefabricated and include fitting and adjustment are also referred to as custom fitted. Classification as custom fitted requires more than minimal self-adjustment at the time of delivery in order to provide an individualized fit, i.e., the item must be trimmed, bent, molded (with or without heat), or otherwise modified resulting in alterations beyond minimal self-adjustment. This fitting method at delivery must require expertise of a certified orthotist or an individual who has specialized training in the provision of an orthosis to fit the item to the individual beneficiary.

With the establishment of this new HCPCS code, suppliers should check the product classification list for any changes that may occur.

Correct coding is an essential element for correct claim payment. The Pricing, Data Analysis and Coding (PDAC) contractor maintains a variety of resources to assist suppliers in determining the appropriate code for Medicare billing. For questions about correct coding, contact the PDAC HCPCS Helpline at (877) 735-1326 during the hours of 9:30 am to 5:00 pm ET, Monday through Friday. You may also visit the PDAC website to chat with a representative, or select the Contact Us website button at the top of the PDAC website for email, FAX, or postal mail information.