Summary & Overview
HCPCS E1813: Dynamic Adjustable Knee Extension Device, Includes Soft Interface Material
HCPCS Level II code E1813 represents a dynamic, adjustable knee extension-only orthotic that includes soft interface material. Nationally, this code captures billing for a class of durable medical equipment used to manage knee extension deficits, post-operative care, contracture prevention, and functional alignment. Its use matters across post-acute care and outpatient rehabilitation because these devices affect mobility outcomes and DME spending.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a compact briefing on clinical context, common sites of service, and typical use cases for knee extension orthoses. The publication outlines benchmark considerations, common modifier usage patterns (input list provided), and payer coverage relevance where available. It highlights where data is provided and notes when input fields were not available.
This summary equips clinicians, billing staff, and policy analysts with a clear understanding of what E1813 denotes, which payers commonly interact with this code, and what to expect in terms of the device’s clinical purpose and service settings. Data not available in the input is explicitly noted where applicable.
Billing Code Overview
HCPCS Level II code E1813 describes a dynamic adjustable knee extension only device that includes soft interface material. The service type for this code is durable medical equipment: knee orthosis (extension-only), dynamic and adjustable, intended to provide controlled extension support to the knee joint. The typical site of service is outpatient clinics, orthotics/prosthetics suppliers, rehabilitation centers, and patient homes where durable medical equipment is fitted or used.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with a history of knee extensor mechanism weakness following total knee arthroplasty presents to an outpatient orthotics clinic for evaluation. The patient complains of persistent difficulty achieving full knee extension during ambulation and reports increased energy expenditure when walking. The orthotist performs an assessment, documents limited active knee extension, and determines a dynamic adjustable knee extension only orthosis is indicated to assist terminal extension and improve gait.
The clinical workflow includes: initial evaluation by an orthopedist or physical medicine and rehabilitation specialist with documentation of functional limitation; referral to a certified orthotist; measurement and fitting of the device; adjustment and patient education on donning/doffing, skin checks, and wearing schedule; follow-up visits for tension adjustments and skin inspection. Durable medical equipment documentation includes device description E1813, justification tied to functional deficit, precise measurements, proof of trial or need, and coding with applicable modifiers for billing and payer adjudication.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier appended; standard reporting | Use when no special circumstance applies. |