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HCPCS Level II K0902: Knee Orthosis, Double Upright, Prefabricated

HCPCS Level II code K0902 denotes a prefabricated, off‑the‑shelf double‑upright knee orthosis with adjustable flexion/extension joint and medial‑lateral/rotation control, optionally with varus/valgus adjustment. This orthotic device is commonly used to stabilize the knee after ligament injuries, during rehabilitation, and for alignment control in degenerative or deformity conditions. Nationally, the code matters because it defines coverage and billing for a widely used class of durable medical equipment that impacts post‑operative care and conservative management of knee instability.

Key payers in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of what the code represents, the clinical contexts in which the device is used, and the typical sites of service. The full publication provides benchmarks for utilization and reimbursement, recent policy updates affecting orthotic coverage, billing considerations for prefabricated versus custom devices, and clinical implications for device selection. Data limitations: modifiers, associated taxonomies, specific ICD‑10 diagnosis linkages, related codes, and payer‑specific coverage details are not available in the input and are noted where applicable in the full report.

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Billing Code Overview

HCPCS Level II code K0902 describes a knee orthosis (KO), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf. This device is designed to provide rigid support and controlled joint motion for patients with knee instability, ligament injuries, postoperative stabilization needs, or deformity requiring varus/valgus control.

Service type: Durable Medical Equipment / Orthotic Device

Typical site of service: Outpatient clinics, orthotic/prosthetic supply facilities, ambulatory surgery centers for post‑operative fitting, and home use following dispensing

Data not available in the input for modifiers, associated taxonomies, ICD-10 diagnoses, related codes, and service line.

Find policies, billing codes, payers, states, and providers

HCPCS Level II K0902: Knee Orthosis, Double Upright, Prefabricated

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Get alerted when payer policies referencing K0902 are released or updated.

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Billing Code Overview

Service type: Durable Medical Equipment / Orthotic Device

Typical site of service: Outpatient clinics, orthotic/prosthetic supply facilities, ambulatory surgery centers for post‑operative fitting, and home use following dispensing

Data not available in the input for modifiers, associated taxonomies, ICD-10 diagnoses, related codes, and service line.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with symptomatic knee instability or post-operative protection following ligament repair who presents to an orthotics clinic after referral from an orthopedic surgeon or physical therapist. The patient may have diagnoses such as a medial collateral ligament sprain, posterolateral corner injury, or proximal tibial fracture requiring a stabilized knee joint. The clinical workflow begins with an initial evaluation by an orthotist or orthopedic clinician to assess joint range of motion, laxity, swelling, and skin integrity. Measurements are taken for an off-the-shelf double upright knee orthosis with adjustable flexion/extension joints (K0902). The orthosis is sized and fitted in clinic; gait and functional checks are performed, and joint stops are set to prescribed flexion/extension limits. Patient education on donning/doffing, skin checks, and activity restrictions is provided. Follow-up visits occur to confirm fit, adjust joint settings (for example to gradually increase allowed flexion), and document functional progress. If the device cannot be fitted or requires customization, the orthotist documents reasons and communicates with the referring provider for next steps.

Coding Specifications

Modifier	Description	When to Use
`RT`	Right side	When the orthosis is supplied for the right lower extremity
`LT`	Left side	When the orthosis is supplied for the left lower extremity
`GZ`	Item or service expected to be denied as not reasonable and necessary	When the supplier believes the item is reasonable and necessary but no prior authorization exists (use per payer rules)
`GA`	Waiver of liability statement on file, no ABN issued	When an Advance Beneficiary Notice is on file for Medicare patients and the supplier has appropriate documentation
`KX`	Requirements specified in the medical policy have been met	When local coverage determination requirements (e.g., documentation of instability, trial of conservative care) are met and documented
`59`	Distinct procedural service	When a separate, distinct orthotic supply or service is provided on the same day as an evaluation or other procedure and documentation supports distinctness
`76`	Repeat procedure by same provider	If the orthotist replaces or refits the same type of off‑the‑shelf orthosis during the same episode and payer policy requires indicating a repeat service
`77`	Repeat procedure by another provider	When a different provider performs a replacement or refitting of the orthosis within a relevant timeframe and payer rules require this modifier
`24`	Unrelated evaluation and management service by same physician during a postoperative period	When an unrelated E/M occurs the same day the orthosis is provided and it is not part of routine postoperative care
`JW`	Drug amount discarded/not administered (placeholder for supplies if applicable)	Rarely used; only if an associated disposable supply element is discarded and payer requires reporting (uncommon for `K0902`)

Taxonomy Code	Specialty	Notes
`207L00000X`	Orthopedic Surgery	Orthopedic surgeons prescribe knee orthoses and manage surgical and postoperative care
`332B00000X`	Orthotics & Prosthetics	Certified orthotists fit and dispense prefabricated and custom orthoses
`2080P0402X`	Physical Medicine & Rehabilitation	Physiatrists assess function and may prescribe orthoses for rehabilitation management
`207R00000X`	Sports Medicine	Sports medicine physicians often manage ligament injuries and prescribe functional knee bracing
`208D00000X`	Physical Therapy	Physical therapists recommend orthoses as part of conservative management and provide gait/functional training

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M23.2X1`	Derangement of meniscus due to old tear or injury, right knee	Meniscal derangement can cause joint instability or dysfunction prompting use of a stabilizing knee orthosis
`S83.411A`	Sprain of anterior cruciate ligament of right knee, initial encounter	ACL sprains commonly require an adjustable knee orthosis for protection during rehabilitation or post‑op recovery
`S83.421A`	Sprain of posterior cruciate ligament of right knee, initial encounter	PCL injuries may be managed with bracing to control flexion/extension while healing
`M23.2X0`	Derangement of meniscus due to old tear or injury, unspecified knee	Degenerative or post‑traumatic meniscal issues treated with conservative bracing when appropriate
`M17.11`	Unilateral primary osteoarthritis, right knee	Moderate osteoarthritis with instability or pain may be managed with a supportive knee orthosis to improve function
`S82.201A`	Unspecified fracture of shaft of tibia, right leg, initial encounter for closed fracture	Post‑fracture stabilization across the knee joint can be aided by a double upright orthosis during healing
`M24.2X1`	Disorder of ligament, right knee	General ligamentous instability treated with a functional knee orthosis to limit harmful motion
`Z96.651`	Presence of right artificial knee joint	After knee arthroplasty an orthosis may be used transiently for protection in select cases

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97760`	Orthotic(s) management and training, upper extremity, lower extremity, and/or trunk, initial fitting and education	Used for initial fitting and patient education when an orthotist or therapist trains the patient on use of the knee orthosis
`97763`	Orthotic(s) management and training, subsequent orthotic(s) fitting, and adjustment(s)	Used for follow-up visits to adjust joint settings, re-fit, or modify the off‑the‑shelf knee orthosis
`99202`	Office or other outpatient visit for the evaluation and management of a new patient, typically 15-29 minutes	Used when a new patient is evaluated by an orthopedist or physiatrist who prescribes the orthosis
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Used for follow-up evaluation related to orthosis use, wound or skin check, or adjustment needs
`20550`	Injection(s); single tendon sheath, or ligament, or ganglion cyst aspiration (when applicable)	Occasionally performed prior to orthosis fitting for symptomatic control (e.g., steroid injection) in related clinical workflows

HCPCS C1300: Hyperbaric Oxygen in Full-Body Chamber, per 30 Minutes

HCPCS-K0901-KNEE-ORTHOSIS-SINGLE-UPRIGHT-PREFABRICATED

HCPCS K0901: Knee Orthosis, Single Upright, Prefabricated

HCPCS-K0903-DIABETIC-CUSTOM-MULTIPLE-DENSITY-INSERT

HCPCS K0903: Custom Multiple-Density Diabetic Foot Insert

HCPCS-K1001-ELECTRONIC-POSITIONAL-OSA-TREATMENT-SENSOR

HCPCS K1001: Electronic Positional Obstructive Sleep Apnea Treatment, with Sensor

HCPCS-K1002-CRANIAL-ELECTROTHERAPY-STIMULATION-SYSTEM

HCPCS K1002: Cranial Electrotherapy Stimulation System

HCPCS-K1003-WHIRLPOOL-TUB-WALK-IN-PORTABLE

HCPCS K1003: Whirlpool Tub, Walk-In, Portable

HCPCS-LEVEL-II-M1144-LIMITED-CONSULTATIVE-THERAPY-1-2-VISITS

HCPCS Level II M1144: Limited/Consultative Therapy, 1-2 Visits

HCPCS-M0064-PSYCHIATRIC-MEDICATION-MANAGEMENT-BRIEF-OFFICE-VISIT

HCPCS M0064: Brief Psychiatric Medication Management Visit

HCPCS-M1000-PAIN-SCREEN-MODERATE-SEVERE

HCPCS M1000: Pain Screened as Moderate to Severe

HCPCS-M1001-PAIN-MANAGEMENT-PLAN-OF-CARE-MODERATE-SEVERE-PAIN

HCPCS Level II M1001: Plan of Care for Moderate to Severe Pain

Showing 1–10 of 16

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`RT`	Right side	When the orthosis is supplied for the right lower extremity
`LT`	Left side	When the orthosis is supplied for the left lower extremity
`GZ`	Item or service expected to be denied as not reasonable and necessary	When the supplier believes the item is reasonable and necessary but no prior authorization exists (use per payer rules)
`GA`	Waiver of liability statement on file, no ABN issued	When an Advance Beneficiary Notice is on file for Medicare patients and the supplier has appropriate documentation
`KX`	Requirements specified in the medical policy have been met	When local coverage determination requirements (e.g., documentation of instability, trial of conservative care) are met and documented
`59`	Distinct procedural service	When a separate, distinct orthotic supply or service is provided on the same day as an evaluation or other procedure and documentation supports distinctness
`76`	Repeat procedure by same provider	If the orthotist replaces or refits the same type of off‑the‑shelf orthosis during the same episode and payer policy requires indicating a repeat service
`77`	Repeat procedure by another provider	When a different provider performs a replacement or refitting of the orthosis within a relevant timeframe and payer rules require this modifier
`24`	Unrelated evaluation and management service by same physician during a postoperative period	When an unrelated E/M occurs the same day the orthosis is provided and it is not part of routine postoperative care
`JW`	Drug amount discarded/not administered (placeholder for supplies if applicable)	Rarely used; only if an associated disposable supply element is discarded and payer requires reporting (uncommon for `K0902`)

Taxonomy Code	Specialty	Notes
`207L00000X`	Orthopedic Surgery	Orthopedic surgeons prescribe knee orthoses and manage surgical and postoperative care
`332B00000X`	Orthotics & Prosthetics	Certified orthotists fit and dispense prefabricated and custom orthoses
`2080P0402X`	Physical Medicine & Rehabilitation	Physiatrists assess function and may prescribe orthoses for rehabilitation management
`207R00000X`	Sports Medicine	Sports medicine physicians often manage ligament injuries and prescribe functional knee bracing
`208D00000X`	Physical Therapy	Physical therapists recommend orthoses as part of conservative management and provide gait/functional training

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M23.2X1`	Derangement of meniscus due to old tear or injury, right knee	Meniscal derangement can cause joint instability or dysfunction prompting use of a stabilizing knee orthosis
`S83.411A`	Sprain of anterior cruciate ligament of right knee, initial encounter	ACL sprains commonly require an adjustable knee orthosis for protection during rehabilitation or post‑op recovery
`S83.421A`	Sprain of posterior cruciate ligament of right knee, initial encounter	PCL injuries may be managed with bracing to control flexion/extension while healing
`M23.2X0`	Derangement of meniscus due to old tear or injury, unspecified knee	Degenerative or post‑traumatic meniscal issues treated with conservative bracing when appropriate
`M17.11`	Unilateral primary osteoarthritis, right knee	Moderate osteoarthritis with instability or pain may be managed with a supportive knee orthosis to improve function
`S82.201A`	Unspecified fracture of shaft of tibia, right leg, initial encounter for closed fracture	Post‑fracture stabilization across the knee joint can be aided by a double upright orthosis during healing
`M24.2X1`	Disorder of ligament, right knee	General ligamentous instability treated with a functional knee orthosis to limit harmful motion
`Z96.651`	Presence of right artificial knee joint	After knee arthroplasty an orthosis may be used transiently for protection in select cases

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97760`	Orthotic(s) management and training, upper extremity, lower extremity, and/or trunk, initial fitting and education	Used for initial fitting and patient education when an orthotist or therapist trains the patient on use of the knee orthosis
`97763`	Orthotic(s) management and training, subsequent orthotic(s) fitting, and adjustment(s)	Used for follow-up visits to adjust joint settings, re-fit, or modify the off‑the‑shelf knee orthosis
`99202`	Office or other outpatient visit for the evaluation and management of a new patient, typically 15-29 minutes	Used when a new patient is evaluated by an orthopedist or physiatrist who prescribes the orthosis
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Used for follow-up evaluation related to orthosis use, wound or skin check, or adjustment needs
`20550`	Injection(s); single tendon sheath, or ligament, or ganglion cyst aspiration (when applicable)	Occasionally performed prior to orthosis fitting for symptomatic control (e.g., steroid injection) in related clinical workflows

HCPCS C1300: Hyperbaric Oxygen in Full-Body Chamber, per 30 Minutes

HCPCS-K0901-KNEE-ORTHOSIS-SINGLE-UPRIGHT-PREFABRICATED

HCPCS K0901: Knee Orthosis, Single Upright, Prefabricated

HCPCS-K0903-DIABETIC-CUSTOM-MULTIPLE-DENSITY-INSERT

HCPCS K0903: Custom Multiple-Density Diabetic Foot Insert

HCPCS-K1001-ELECTRONIC-POSITIONAL-OSA-TREATMENT-SENSOR

HCPCS K1001: Electronic Positional Obstructive Sleep Apnea Treatment, with Sensor

HCPCS-K1002-CRANIAL-ELECTROTHERAPY-STIMULATION-SYSTEM

HCPCS K1002: Cranial Electrotherapy Stimulation System

HCPCS-K1003-WHIRLPOOL-TUB-WALK-IN-PORTABLE

HCPCS K1003: Whirlpool Tub, Walk-In, Portable

HCPCS-LEVEL-II-M1144-LIMITED-CONSULTATIVE-THERAPY-1-2-VISITS

HCPCS Level II M1144: Limited/Consultative Therapy, 1-2 Visits

HCPCS-M0064-PSYCHIATRIC-MEDICATION-MANAGEMENT-BRIEF-OFFICE-VISIT

HCPCS M0064: Brief Psychiatric Medication Management Visit

HCPCS-M1000-PAIN-SCREEN-MODERATE-SEVERE

HCPCS M1000: Pain Screened as Moderate to Severe

HCPCS-M1001-PAIN-MANAGEMENT-PLAN-OF-CARE-MODERATE-SEVERE-PAIN

HCPCS Level II M1001: Plan of Care for Moderate to Severe Pain

Showing 1–10 of 16

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

HCPCS Level II K0902: Knee Orthosis, Double Upright, Prefabricated

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Billing Code Overview

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HCPCS Level II K0902: Knee Orthosis, Double Upright, Prefabricated

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References