HCPCS Level II K1007: Powered Bilateral Lower‑Extremity Orthosis - OpenPayer

Summary & Overview

HCPCS Level II K1007: Powered Bilateral Lower‑Extremity Orthosis

HCPCS Level II code K1007 identifies a powered bilateral lower‑extremity orthosis with a pelvic component and single or double uprights, designed to support hips, knees, ankles, and feet and incorporating motors, microprocessors, and sensors. This high‑complexity durable medical equipment (DME) supports mobility and functional standing or ambulation for patients with significant bilateral lower‑limb weakness or neuromuscular impairment. Nationally, K1007 matters because it represents an advanced class of assistive device with substantial clinical and cost implications for payers and DME suppliers.

Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical role of the device, typical settings where it is provided, and payer coverage considerations. The publication summarizes benchmark payment and utilization context where available, highlights coding and billing considerations relevant to DME and prosthetics suppliers, and outlines the clinical scenarios that commonly lead to use of such powered bilateral orthoses.

The report does not provide individualized clinical guidance or procurement recommendations. It offers national‑level context for coding, reimbursement pathways, and service delivery models associated with complex powered bilateral lower‑extremity orthoses billed with HCPCS Level II code K1007.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareK1007HCPCS Level IIpowered orthosisdurable medical equipmentprosthetics and orthoticsmobility devicesrehabilitationDME billingassistive technology

Billing Code Overview

HCPCS Level II code K1007 describes a powered bilateral lower‑extremity orthotic device that includes a pelvic component and single or double uprights. The device provides support for both hips, knees, ankles, and feet and may include knee joints (any type) and ankle joints (any type). The description indicates the device includes all components and accessories, including motors, microprocessors, and sensors.

Service type: Durable medical equipment — complex powered bilateral lower‑extremity orthosis

Typical site of service: Outpatient durable medical equipment (DME) suppliers, prosthetics and orthotics clinics, and ambulatory rehabilitation settings

Clinical & Coding Specifications

Clinical Context

A 56-year-old male with long-standing neuromuscular weakness and bilateral lower-extremity joint instability presents for provision of a powered bilateral hip–knee–ankle–foot orthosis described by billing code K1007. The patient ambulates with significant energy expenditure, frequent stumbles, and progressive decline in community mobility. Therapy and prior orthoses were insufficient. A physiatrist evaluates gait, performs a detailed musculoskeletal and neurological exam, documents objective gait impairment, and orders gait analysis and measurements. An orthotist performs casting and fitting visits; the device includes pelvic component, single or double uprights, knee joints, ankle joints, embedded motors, microprocessors and sensors for powered assistance. The clinical workflow includes: initial physician evaluation and documentation of functional deficits; preauthorization with the patient’s payor (for example, Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, BUCA, Medicare); ordering of the custom powered orthosis; orthotic fabrication and iterative fittings; training with physical therapy for device use, donning/doffing, and safety; and final physician sign-off for delivery and durable medical equipment billing. Follow-up visits assess fit, alignment, and functional gains, with adjustments billed as appropriate.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — standard billing

HCPCS K1036: Low-Frequency Ultrasonic Diathermy Supplies, Monthly

HCPCS-K1017-MONTHLY-SUPPLIES-DURABLE-MEDICAL-EQUIPMENT

HCPCS K1017: Monthly Supplies for Durable Medical Device Use

HCPCS-K1019-UPPER-LIMB-TREMOR-STIMULATOR-SUPPLIES

HCPCS K1019: Supplies for External Upper Limb Tremor Stimulator

HCPCS-K1013-ENEMA-TUBE-REPLACEMENT

HCPCS Level II K1013: Enema Tube, Replacement Only

HCPCS-K1014-ENDOSKELETAL-KNEE-SHIN-4-BAR-FLUID-CONTROL

HCPCS K1014: Endoskeletal Knee-Shin System with Fluid Swing/Stance Control

HCPCS-K1033-NON-PNEUMATIC-SEQUENTIAL-COMPRESSION-HALF-LEG

HCPCS Level II K1033: Non-pneumatic Sequential Compression Garment, Half Leg

HCPCS-K1006-HOME-SUCTION-PUMP-URINE-MANAGEMENT

HCPCS K1006: Home Suction Pump for External Urine Management

HCPCS-K1011-ACTIVATION-DEVICE-INTRAURETHRAL-DRAINAGE-VALVE-REPLACEMENT

HCPCS Level II K1011: Activation Device for Intraurethral Drainage Valve

HCPCS-K1023-DISTAL-TEN-UPPER-ARM-STIMULATOR

HCPCS K1023: Distal Transcutaneous Electrical Nerve Stimulator, Upper Arm

HCPCS-K1026-NASAL-ALLERGEN-BARRIER-CREAM

HCPCS K1026: Mechanical Allergen Barrier/Inhalation Filter, Nasal Cream

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Taxonomy Code	Specialty	Notes
`225100000X`	Physical Medicine & Rehabilitation (Physiatry)	Physician evaluation, goals, and medical necessity documentation.
`333600000X`	Prosthetics & Orthotics	Certified orthotist responsible for measurement, fabrication, fitting, and adjustments.
`208000000X`	Physical Therapy	Gait training, device training, and functional outcome assessments.
`207Q00000X`	Occupational Therapy	Activities of daily living training and adaptive technique instruction.
`282N00000X`	Orthopedic Surgery	Surgical colleagues involved when joint pathology or surgical history influences orthotic design.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G82.50`	Paraplegia, unspecified	Severe bilateral lower-extremity motor impairment often requiring powered bilateral orthoses for ambulation support.
`G83.4`	Cauda equina syndrome	Bilateral lower-extremity weakness and sensory loss that may necessitate advanced orthotic support.
`G12.21`	Amyotrophic lateral sclerosis	Progressive motor neuron disease causing progressive weakness where powered orthoses can assist mobility.
`G35`	Multiple sclerosis	Demyelinating disease causing gait impairment and fatigue; powered orthoses can improve endurance and stability.
`M16.9`	Osteoarthritis of hip, unspecified	Severe bilateral hip joint pathology that may be part of combined indications when motorized hip–knee–ankle–foot device is considered.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97760`	Orthotic management and training, initial encounter; with training by provider, with evaluation and fitting of orthosis, one or more areas, lower extremity	Commonly performed by physical therapists at initial device delivery and training sessions.
`97761`	Prosthetic training, initial encounter	Used if prosthetic-style training protocols are applied for gait and device ambulation techniques.
`97530`	Therapeutic activities, direct (one-on-one) patient contact	Used during therapy sessions to improve functional mobility with the powered orthosis.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	Used by the physiatrist for follow-up visits documenting device effectiveness and medical necessity.
`97763`	Orthotic and prosthetic supply, fitting and adjustment of a prosthesis or orthosis	Used for billing specific fitting/adjustment services associated with device delivery.

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