HCPCS L1812: Knee Orthosis, Elastic with Joints, Prefabricated

HCPCS Level II code L1812 describes a prefabricated, off-the-shelf knee orthosis that is elastic with joints, intended to provide knee support and joint stabilization; the service is durable medical equipment for orthotic management and is typically supplied in outpatient clinics, orthotics/prosthetics providers, and retail medical supply settings.

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HCPCS L1812: Knee Orthosis, Elastic with Joints, Prefabricated

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Clinical & Coding Specifications

Clinical Context

A middle-aged patient presents to an outpatient orthopedic clinic after a lateral meniscal tear confirmed by MRI, reporting knee pain, swelling, and episodic instability with ambulation. The treating orthopedic surgeon or physician assistant evaluates the patient, documents range of motion, ligament stability, and functional limitations, and determines a conservative management plan that includes off-the-shelf knee support. A certified orthotist or medical equipment provider fits a prefabricated elastic knee orthosis with joints to provide medial-lateral support and controlled motion. The device is dispensed in the clinic or at a durable medical equipment (DME) supplier; the visit includes assessment, fitting, patient education on donning/doffing and skin checks, and documentation of medical necessity. Typical sites of service are outpatient orthopedics clinics, physical therapy clinics with DME capability, and DME supplier storefronts. Patients commonly return for follow-up to assess fit, comfort, and need for modification or replacement; documentation supports continued coverage or escalation to a custom knee orthosis if conservative care fails.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Used for the clinic visit during which the orthosis is evaluated, prescribed, and initial fitting occurs
`97760`	Orthotic(s) management and training, upper extremity, lower extremity and/or trunk, initial encounter; 15 minutes	Used for patient education, donning/doffing training, and gait or function training associated with the knee orthosis
`99070`	Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit	Use if additional non-standard supplies (padding, straps) are provided during fitting
`99455`	Work related or medical disability examination; request for work-related or medical disability examination	May be used when brace fitting is part of a work-related functional assessment (billing depends on payer and setting)
`20550`	Injection(s); single tendon sheath, or ligament, or ganglion cyst (if applicable)	Sometimes performed before bracing in patients receiving corticosteroid injections for inflammatory conditions; related in the same care pathway

Related Modifiers

5 rows

Modifier	Description	When to Use
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
56	Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…	- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
207K00000X	Allergy & Immunology Physician	An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
207P00000X	Emergency Medicine Physician	An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospit…
251E00000X	Home Health Agency	A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing se…
261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
363LA2100X	Acute Care Nurse Practitioner	Physician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
2085R0203X	Therapeutic Radiology Physician	Therapeutic Radiology certificate name was changed to Radiation Oncology. Use Radiation Oncology.

HCPCS L0112: Cranial Cervical Orthosis, Congenital Torticollis Type

HCPCS-L0113-CRANIAL-CERVICAL-ORTHOSIS-TORTICOLLIS

HCPCS Level II L0113: Prefabricated Cranial Cervical Orthosis for Torticollis

HCPCS-L0130-CERVICAL-FLEXIBLE-THERMOPLASTIC-COLLAR-MOLDED-TO-PATIENT

HCPCS Level II L0130: Cervical Flexible Thermoplastic Collar, Molded to Patient

HCPCS-L0140-CERVICAL-SEMI-RIGID-ADJUSTABLE-PLASTIC-COLLAR

HCPCS Level II L0140: Cervical Semi-Rigid Adjustable Plastic Collar

HCPCS-L0150-CERVICAL-SEMI-RIGID-ADJUSTABLE-CHIN-CUP

HCPCS Level II L0150: Cervical Semi-Rigid Adjustable Chin Cup

HCPCS-L0160-CERVICAL-SEMI-RIGID-OCCIPITAL-MANDIBULAR-SUPPORT

HCPCS Level II L0160: Cervical Semi-Rigid Occipital/Mandibular Support

HCPCS-L0170-CERVICAL-COLLAR-MOLDED-TO-PATIENT-MODEL

HCPCS Level II L0170: Cervical Collar, Custom-Molded

HCPCS-L0172-CERVICAL-COLLAR-SEMI-RIGID-THERMOPLASTIC-FOAM

HCPCS L0172: Cervical Collar, Semi-Rigid Prefabricated

HCPCS-L0174-CERVICAL-COLLAR-SEMI-RIGID-THORACIC-EXTENSION

HCPCS L0174: Cervical Collar, Semi-Rigid Thermoplastic with Thoracic Extension

HCPCS-L0180-CERVICAL-MULTIPLE-POST-COLLAR-OCCIPITAL-MANDIBULAR-ADJUSTABLE

HCPCS Level II L0180: Cervical Orthosis with Occipital/Mandibular Supports

Showing 1–10 of 466

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Used for the clinic visit during which the orthosis is evaluated, prescribed, and initial fitting occurs
`97760`	Orthotic(s) management and training, upper extremity, lower extremity and/or trunk, initial encounter; 15 minutes	Used for patient education, donning/doffing training, and gait or function training associated with the knee orthosis
`99070`	Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit	Use if additional non-standard supplies (padding, straps) are provided during fitting
`99455`	Work related or medical disability examination; request for work-related or medical disability examination	May be used when brace fitting is part of a work-related functional assessment (billing depends on payer and setting)
`20550`	Injection(s); single tendon sheath, or ligament, or ganglion cyst (if applicable)	Sometimes performed before bracing in patients receiving corticosteroid injections for inflammatory conditions; related in the same care pathway

Related Modifiers

5 rows

Modifier	Description	When to Use
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
56	Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…	- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
207K00000X	Allergy & Immunology Physician	An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
207P00000X	Emergency Medicine Physician	An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospit…
251E00000X	Home Health Agency	A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing se…
261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
363LA2100X	Acute Care Nurse Practitioner	Physician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
2085R0203X	Therapeutic Radiology Physician	Therapeutic Radiology certificate name was changed to Radiation Oncology. Use Radiation Oncology.

HCPCS L0112: Cranial Cervical Orthosis, Congenital Torticollis Type

HCPCS-L0113-CRANIAL-CERVICAL-ORTHOSIS-TORTICOLLIS

HCPCS Level II L0113: Prefabricated Cranial Cervical Orthosis for Torticollis

HCPCS-L0130-CERVICAL-FLEXIBLE-THERMOPLASTIC-COLLAR-MOLDED-TO-PATIENT

HCPCS Level II L0130: Cervical Flexible Thermoplastic Collar, Molded to Patient

HCPCS-L0140-CERVICAL-SEMI-RIGID-ADJUSTABLE-PLASTIC-COLLAR

HCPCS Level II L0140: Cervical Semi-Rigid Adjustable Plastic Collar

HCPCS-L0150-CERVICAL-SEMI-RIGID-ADJUSTABLE-CHIN-CUP

HCPCS Level II L0150: Cervical Semi-Rigid Adjustable Chin Cup

HCPCS-L0160-CERVICAL-SEMI-RIGID-OCCIPITAL-MANDIBULAR-SUPPORT

HCPCS Level II L0160: Cervical Semi-Rigid Occipital/Mandibular Support

HCPCS-L0170-CERVICAL-COLLAR-MOLDED-TO-PATIENT-MODEL

HCPCS Level II L0170: Cervical Collar, Custom-Molded

HCPCS-L0172-CERVICAL-COLLAR-SEMI-RIGID-THERMOPLASTIC-FOAM

HCPCS L0172: Cervical Collar, Semi-Rigid Prefabricated

HCPCS-L0174-CERVICAL-COLLAR-SEMI-RIGID-THORACIC-EXTENSION

HCPCS L0174: Cervical Collar, Semi-Rigid Thermoplastic with Thoracic Extension

HCPCS-L0180-CERVICAL-MULTIPLE-POST-COLLAR-OCCIPITAL-MANDIBULAR-ADJUSTABLE

HCPCS Level II L0180: Cervical Orthosis with Occipital/Mandibular Supports

Showing 1–10 of 466

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

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

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HCPCS L1812: Knee Orthosis, Elastic with Joints, Prefabricated

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HCPCS L1812: Knee Orthosis, Elastic with Joints, Prefabricated

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

HCPCS L1812: Knee Orthosis, Elastic with Joints, Prefabricated

Sign up for hcpcs L1812 policy alerts

HCPCS L1812: Knee Orthosis, Elastic with Joints, Prefabricated

Sign up for hcpcs L1812 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What device and service does HCPCS code L1812 describe?

What clinical conditions or scenarios are relevant for billing L1812?

Which billing modifiers are relevant when submitting claims for L1812?

What CPT codes are commonly billed in conjunction with L1812?

Which payers are referenced for coverage and reimbursement guidance for L1812?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What device and service does HCPCS code L1812 describe?

What clinical conditions or scenarios are relevant for billing L1812?

Which billing modifiers are relevant when submitting claims for L1812?

What CPT codes are commonly billed in conjunction with L1812?

Which payers are referenced for coverage and reimbursement guidance for L1812?

References