Summary & Overview
HCPCS E1823: Dynamic Adjustable Ankle Flexion Device, Soft Interface
HCPCS Level II code E1823 represents a dynamic, adjustable ankle flexion-only orthotic device with soft interface material. These devices are prescribed to support and control ankle motion in patients who require adjustable dorsiflexion or plantarflexion assistance, and they matter nationally due to their role in mobility, rehabilitation, and durable medical equipment (DME) coverage decisions. Payers commonly address coverage, documentation, and medical necessity for ankle orthoses when determining reimbursement and patient access.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the device, typical sites of service, common billing modifiers associated with HCPCS Level II supply and DME claims, and guidance on where to find additional coding and coverage details. The publication summarizes benchmarking expectations and common payer approaches where available and identifies missing input fields such as associated taxonomies, specific ICD-10 diagnoses, and related codes. This summary is intended for a national audience of billing professionals, clinicians, and policy analysts seeking a concise reference for HCPCS Level II code E1823 and its administrative context.
Billing Code Overview
HCPCS Level II code E1823 describes a dynamic adjustable ankle flexion only device that includes soft interface material. This device is intended to provide adjustable dorsiflexion/plantarflexion assistance for the ankle joint while using a soft contact surface against the patient.
Service type: Durable medical equipment / orthotic device for ankle support and motion control.
Typical site of service: Outpatient clinics, orthotics/prosthetics centers, home use.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 54-year-old patient presents to an orthopedic or prosthetics clinic with progressive ankle dorsiflexion weakness and foot drop following a peripheral nerve injury sustained during a motor vehicle collision. The patient ambulates with an antalgic gait and frequent tripping. After clinical evaluation, including neurologic exam and gait assessment, the treating clinician (orthopedic surgeon or physical medicine and rehabilitation physician) refers the patient to a certified orthotist for fabrication and fitting of a dynamic adjustable ankle–foot orthosis to provide dorsiflexion assist while allowing plantarflexion for functional push-off. The orthotist evaluates limb anatomy, measures for a custom device, documents functional goals (improve clearance in swing phase, prevent falls), and adjusts dynamic tension to balance assistance and comfort. Follow-up visits occur at 1–2 weeks for initial fit, at 6–8 weeks for adjustments, and periodically thereafter for wear-related changes, skin inspection, and device maintenance. The device billed with code E1823 is provided with a soft interface and dynamic flexion-only mechanism that supplies dorsiflexion assistance without restricting plantarflexion, suitable for community ambulation and activities of daily living.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard reporting when no modifier applies |