Suggested HCPCS Code: L4396/L4397

• Soft, flexible brace
• Easily fasten and adjust with Velcro closures
• Gentle stretch provided through simple dorsiflexion strap
• Fits either left or right foot

Underlying Conditions:

• Plantar Fascial Fibromatosis
• Contracture of Ankle
• Contracture of Foot
• Cervical Disc Disorder with Radiculopathy/Myelopathy

Coverage Criteria: (Patient must meet one of the following criteria)

• Plantar Fasciitis

Or all of the following:

• Plantar flexion contracture of the ankle with dorsiflexion on passive range of motion testing (using Goniometer) of at least 10 degrees.
• Reasonable expectation of the ability to correct the contracture
• Contracture is interfering/expected to interfere significantly with functional abilities
• Splint is used as part of therapy program including active stretching of the involved muscles/tendons

Suggested HCPCS Code: L4396/L4397

• Essential treatment for alleviation of night time plantar fasciitis pain
• Three padded straps with buckles to ensure immobilization
• Dual tension straps allow for increased flexion and foot angle for the optimum pain-relieving stretch
• Lightweight night splint, low profile shell is sturdy
• and breathable for proper plantar fasciitis treatment

Underlying Conditions:

• Plantar Fascial Fibromatosis
• Contracture of Ankle
• Contracture of Foot

Coverage Criteria: (Patient must meet one of the following criteria)

• Plantar Fasciitis

Or all of the following:

• Plantar flexion contracture of the ankle with dorsiflexion on passive range of motion testing (using Goniometer) of at least 10 degrees.
• Reasonable expectation of the ability to correct the contracture
• Contracture is interfering/expected to interfere significantly with functional abilities
• Splint is used as part of therapy program including active stretching of the involved muscles/tendons

Suggested HCPCS Code: L4396/L4397

• Flex Technology splint moves with the patient’s abnormal muscle tone and spasticity for comfort and helps to relax the abnormal muscle tone
• Anti-rotation bar prevents rolling of the patient’s leg
• Non-slip sole allows brief standing and walking
• Dorsiflexion assist (flex) straps (aid in proper alignment of the foot and adjustable tension helps to control plantar flexion
• Toe support has “toe off” angle to assist in gait training and short ambulation
• Available in fleece lining
• Available with Flo Form

Underlying Conditions:

• Plantar Fascial Fibromatosis
• Contracture of Ankle
• Contracture of Foot

Coverage Criteria: (Patient must meet one of the following criteria)

• Plantar Fasciitis

Or all of the following:

• Plantar flexion contracture of the ankle with dorsiflexion on passive range of motion testing (using Goniometer) of at least 10 degrees.
• Reasonable expectation of the ability to correct the contracture
• Contracture is interfering/expected to interfere significantly with functional abilities
• Splint is used as part of therapy program including active stretching of the involved muscles/tendons

Suggested HCPCS Code: L4396 & L2210x2

• Only dorsiflexion brace that fully extends the leg
• Ensures gastric-soleus stretch
• Controls ankle joint placement
• Engages windlass mechanism

Underlying Conditions:

• Plantar Fascial Fibromatosis
• Contracture of Ankle
• Contracture of Foot

Coverage Criteria: (Patient must meet one of the following criteria)

• Plantar Fasciitis

Or all of the following:

• Plantar flexion contracture of the ankle with dorsiflexion on passive range of motion testing (using Goniometer) of at least 10 degrees.
• Reasonable expectation of the ability to correct the contracture
• Contracture is interfering/expected to interfere significantly with functional abilities
• Splint is used as part of therapy program including active stretching of the involved muscles/tendons

Suggested HCPCS Code: L4360/L4361

• Air bladders for customized compression
• Hook and fastening straps for quick, easy fitting and adjustments
• Velcro straps and padded insole for comfort and fit
• Fits either left or right foot

Underlying Conditions:

• Ankle Sprain
• Ankle Fracture
• Foot Fracture
• Tendinitis
• Flexion Deformity
• Plantar Fascitis
• Ankle Instability

Coverage Criteria: 

• Patient is ambulatory with weakness or deformity of the foot and ankle requiring stabilization for medical reasons and has the potential to benefit functionally from the boot