Suggested HCPCS Code: L1830

• Universal sizing will fit most patients
• Elastic velcro straps allow for added compression
• Two movable stays for medial and lateral placement
• Contoured posterior stays for extra rigidity

Underlying Conditions:

• Knee Derangement
• ACL Tear
• Congenital Deformity of Knee Joint
• Chondromalacia of Patella
• Old Bucket Handle of Medial Meniscus
• Pathologic Fracture of Femur/Tibia/Fibula
• Disruption of MCL
• Rheumatoid Arthritis
• Osteoarthritis

Coverage Criteria:

• Recent knee injury or recent surgical procedure on knee

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Suggested HCPCS Code: L1830

• Easy to fit with “slide to size” straps
• Dual cuffs and popliteal supports for exact immobilization
• Sleeve under brace for patient warmth
• Durable, comfortable and latex free

Underlying Conditions:

• Knee Derangement
• ACL Tear
• Congenital Deformity of Knee Joint
• Chondromalacia of Patella
• Old Bucket Handle of Medial Meniscus
• Pathologic Fracture of Femur/Tibia/Fibula
• Disruption of MCL
• Rheumatoid Arthritis
• Osteoarthritis

Coverage Criteria:

• Recent knee injury or recent surgical procedure on knee

Suggested HCPCS Code: L1831

• Easy to use pull ring and lock mechanism
• Six possible positions
• No additional tools necessary
• Removable, machine washable cover

Underlying Conditions:

• Knee Contracture

Coverage Criteria:

• Patient has flexion or extension contractures of the knee with movement on passive range of motion testing of at least 10 degrees

Suggested HCPCS Code: E1810

• Goniometer dial can be set to a range of flexion or extension in 5° increments
• Provides excellent support for flaccid or weak extremities and helps immobilize painful extremities
• Patented malleable splint spine can bend to the desired ROM and the cuffs can adjusted for optimal fit.

Underlying Conditions:

• Knee Contracture

Coverage Criteria:

• Patient has flexion or extension contractures of the knee with movement on passive range of motion testing of at least 10 degrees

Suggested HCPCS Code: L1831

• Provides prolonged low load passive stretch and treats hyper extension of the knee
• Adjustable dials allow gradual changes to move the joint toward normal alignment
• Brace provides 3-point leverage similar to manual stretching improving range of motion
• Padding provides comfort and redistributes skin pressure
• High-temperature plastic cuffs can be remolded to custom fit the patient’s upper and lower legs.

Underlying Conditions:

• Knee Contracture

Coverage Criteria:

• Patient has flexion or extension contractures of the knee with movement on passive range of motion testing of at least 10 degrees

Suggested HCPCS Code: L1831

• X strap for complete knee range of motion
• Air technology uses 2 air bladders at the back of the leg to redistribute skin pressure
• Bilateral hinged uprights work with the air bladders to continue to move the joint toward normal alignment
• Hinges can be removed for the most severe flexion contracture and added as the range improves
• Soft, breathable fabric helps keep the patient’s leg cool and dry

Underlying Conditions:

• Knee Contracture

Coverage Criteria:

• Patient has flexion or extension contractures of the knee with movement on passive range of motion testing of at least 10 degrees

Suggested HCPCS Code: L1831

• X strap for complete knee range of motion
• Adjustable dials lock in to apply mild stretch
• Side bars flex when patient draws inward, then brings the joint back to preset position
• Gradually reset dials to work joint toward normal alignment and re-lengthen shortened tissue

Underlying Conditions:

• Knee Contracture

Coverage Criteria:

• Patient has flexion or extension contractures of the knee with movement on passive range of motion testing of at least 10 degrees

Suggested HCPCS Code: L1845/L1852

• Sleek, low profile design
• Durable, lightweight aluminum construction
• Flexion (45°, 60°, 75°, 90°) and extension (0°, 10°, 20°, 30°, 40°) stops

Underlying Conditions:

• ACL Tear
• Congenital Deformity of Knee Joint
• Chondromalacia of Patella
• Old Bucket Handle of Medial Meniscus
• Pathologic Fracture of Femur/Tibia/Fibula
• Rheumatoid Arthritis
• Osteoarthritis

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

• Recent knee injury or Recent surgical procedure on knee
• Patient is ambulatory and has knee instability due to diagnosis stabilization

Suggested HCPCS Code: L1843/L1851

• Unique air blatter unloading
• Soft OA that reduces migration
• Single Upright ROM hinge
• Lightweight
• Comfortable
• Easy to use

Underlying Conditions:

• Congenital Deformity of Knee Joint
• Chondromalacia of Patella
• Old Bucket Handle of Medial Meniscus
• Pathologic Fracture of Femur/Tibia/Fibula
• Rheumatoid Arthritis
• Osteoarthritis

Coverage Criteria: Patient must meet one of the following criteria

• Recent knee injury or Recent surgical procedure on knee
• Patient is ambulatory and has knee instability due to diagnosis stabilization

Suggested HCPCS Code: L1843/L1851

• Design with quick release snaps for easy on-off
• Three point knee pressure reduction system
• Varus and Valgus adjustment for perfect alignment
• Easily adjust hinge setting

Underlying Conditions:

• Congenital Deformity of Knee Joint
• Chondromalacia of Patella
• Old Bucket Handle of Medial Meniscus
• Pathologic Fracture of Femur/Tibia/Fibula
• Rheumatoid Arthritis
• Osteoarthritis

Coverage Criteria: Patient must meet one of the following criteria

• Recent knee injury or Recent surgical procedure on knee
• Patient is ambulatory and has knee instability due to diagnosis stabilization

Suggested HCPCS Code: L1843/L1851

• 3-point fixation grasps medially and laterally for optimum off-loading force
• Adjustable flexion/extension control
• Low profile uprights, reduce hitting opposite knee especially for bi-lateral wearers
• Anterior/posterior calf/thigh straps secure uprights for proper alignment along sides of leg and helps prevent migration

Underlying Conditions:

• Osteoarthritis
• Congenital Deformity of Knee Joint
• Chondromalacia of Patella
• Old Bucket Handle of Medial Meniscus
• Pathologic Fracture of Femur/Tibia/Fibula
• Rheumatoid Arthritis

Coverage Criteria: Patient must meet one of the following criteria

• Recent knee injury or Recent surgical procedure on knee
• Patient is ambulatory and has knee instability due to diagnosis stabilization

Suggested HCPCS Code: L1820

• Wrap Design for customized fit
• Bilateral, Lightweight, Breathable
• Universal Sizing for a customized fit
• Available with patella stabilizing donut buttress

Underlying Conditions:

• Chronic Knee Instability
• Rheumatoid Arthritis
• Pathologic Fracture of Femur/Fibia/Fibula
• Congenital Deformity of Knee Joint
• Osteoarthritis
• Patella Fracture
• Derangement of Meniscus due to Tear or Injury

Coverage Criteria:

• Ambulatory patient with weakness or deformity of the knee requiring stabilization

Suggested HCPCS Code: L1820

• Wrap-around straps secure uprights/hinges in position and minimize migration.
• Soft popliteal knit prevents “bunching”
• Perforated, breathable skin-friendly neoprene with polycentric hinges
• Pressure relieving, stabilizing patella shaped silicone buttress

Underlying Conditions:

• Chronic Knee Instability
• Rheumatoid Arthritis
• Pathologic Fracture of Femur/Fibia/Fibula
• Congenital Deformity of Knee Joint
• Osteoarthritis
• Patella Fracture
• Derangement of Meniscus due to Tear or Injury

Coverage Criteria:

• Ambulatory patient with weakness or deformity of the knee requiring stabilization

Suggested HCPCS Code: L1832/L1833

• Wrap Design for customized fit
• Bilateral, Lightweight, Breathable
• Universal Sizing for a customized fit
• Easy to set hinges, no tools needed

Underlying Conditions:

• Congenital Deformity of Knee Joint
• Pathologic Fracture of Femur/Tibia/Fibula
• Patella Fracture
• Rheumatoid Arthritis
• Derangement of Meniscus Due to Tear or Injury
• Chondromalacia of Patella
• Osteoarthritis

Coverage Criteria: Patient must meet one of the following criteria

• Recent knee injury or recent surgical procedure on knee
• Patient is ambulatory and has knee instability due to diagnosis

Suggested HCPCS Code: L1832/L1833

• Snap-in flexion and extension stops included
• Soft popliteal knit prevents “bunching”
• Perforated, breathable skin-friendly neoprene with polycentric hinges
• Pressure relieving, stabilizing patella shaped silicone buttress

Underlying Conditions:

• Congenital Deformity of Knee Joint
• Pathologic Fracture of Femur/Tibia/Fibula
• Patella Fracture
• Rheumatoid Arthritis
• Derangement of Meniscus Due to Tear or Injury
• Chondromalacia of Patella
• Osteoarthritis

Coverage Criteria: Patient must meet one of the following criteria

• Recent knee injury or recent surgical procedure on knee
• Patient is ambulatory and has knee instability due to diagnosis