HCPCS Level II L1843: Knee Orthosis, Single Upright with Adjustable Joint

HCPCS Level II code L1843 describes a prefabricated knee orthosis, single upright with thigh and calf supports, featuring an adjustable flexion/extension joint (unicentric or polycentric) and medial-lateral and rotation control; the item is customized to a specific patient by trimming, bending, molding, assembling, or other modification. Service type: orthotic device fabrication and fitting. Typical site of service: outpatient orthotics/prosthetics clinic or durable medical equipment provider setting.

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HCPCS Level II L1843: Knee Orthosis, Single Upright with Adjustable Joint

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Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with moderate-to-severe knee osteoarthritis and episodic instability is evaluated in an orthopedic clinic. The treating clinician (orthopedist or physiatrist) documents objective findings including joint line tenderness, varus/valgus laxity on stress testing, and a limited gait due to pain and instability. Conservative care (activity modification, NSAIDs, physical therapy) has been attempted with incomplete symptom relief. A prefabricated knee orthosis described by L1843 (single upright, thigh and calf, adjustable flexion/extension joint, medial-lateral and rotation control, with or without varus/valgus adjustment) is selected and customized by a licensed orthotist to improve alignment, reduce pain, and provide medial-lateral stability during ambulation.

The clinical workflow includes an office evaluation with documented medical necessity, a written order from the treating physician specifying L1843, measurement and fitting by an orthotic specialist, any required customization (trimming, bending, molding, or joint adjustment) performed by an individual with expertise, delivery of the device with patient education on use and skin checks, and follow-up visits to assess fit and function. Durable medical equipment (DME) administrative steps include verification of patient insurance coverage (examples: Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, BUCA, Medicare), preauthorization if required, and submission of claims with appropriate ICD-10 diagnosis codes and modifiers documenting laterality and services rendered.

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	Commonly used for the physician visit when prescribing or re-evaluating the orthosis and documenting medical necessity
`97760`	Orthotic management and training, initial encounter (eg, fitting and training with orthosis)	Used by therapists or orthotists for patient training and gait/functional training after delivery of the orthosis
`97763`	Orthotic/prosthetic management and training, subsequent encounter	Used for follow-up orthotic management visits to adjust fit and provide additional training
`99070`	Supplies and materials (over and above those usually included with the office visit)	May be used by suppliers to bill for additional consumable items provided with the orthosis (confirm payer rules)
`99456`	Work-related or medical disability examination services (impairment rating)	Occasionally used when an orthosis is provided in the context of workers' compensation functional assessment (use per payer/work comp rules)

Related Modifiers

5 rows

Modifier	Description	When to Use
95	Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…	- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…
55	Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…	- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
3P	The CPT Category II modifier -3P denotes a performance‑measure exclusion when a required quality action was not performed because of system‑level constraints. It is appended only to Category II…	- When to apply: Use CPT Category II modifier 3P only with Category II (‘‘F’’) codes when a specific quality measure’s specifications allow a system‑level exclusion — append 3P to indicate the…
92	Modifier 92 (Alternative Laboratory Platform Testing) is used when laboratory tests are performed with single‑use, disposable, portable kits or transportable instruments. The AMA defines it for tests…	- Use modifier 92 when a laboratory test is performed using a single‑use, disposable analytical device or kit (an alternative laboratory platform) that is portable and may be taken to or near the…
63	Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…	- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
2086S0102X	Surgical Critical Care Physician	A surgeon with expertise in the management of the critically ill and postoperative patient, particularly the trauma victim, who specializes in critica…
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…
363A00000X	Physician Assistant	A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and…
103TM1700X	Deactivated - Psychologist Men & Masculinity
207VC0200X	Critical Care Medicine (Obstetrics & Gynecology) Physician	An obstetrician/gynecologist, who specializes in critical care medicine diagnoses, treats and supports female patients with multiple organ dysfunction…
207RS0012X	Sleep Medicine (Internal Medicine) Physician	An Internist who practices Sleep Medicine is certified in the subspecialty of sleep medicine and specializes in the clinical assessment, physiologic t…
2251G0304X	Geriatric Physical Therapist	A licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Geriatric Physical Therapy, who has d…
293D00000X	Physiological Laboratory	A laboratory that operates independently of a hospital and physician's office to furnish physiological diagnostic services (e.g. EEG's , EKG's, scans,…

Related ICD-10-CM Codes

21 rows

ICD-10-CM Code	Description
M17.0	Bilateral primary osteoarthritis of knee
M17.11	Unilateral primary osteoarthritis, right knee
M17.12	Unilateral primary osteoarthritis, left knee
M17.9	Osteoarthritis of knee, unspecified
M22.2X1	Patellofemoral disorders, right knee
M22.2X2	Patellofemoral disorders, left knee
M23.8X1	Other internal derangements of right knee
M23.8X2	Other internal derangements of left knee
M25.461	Effusion, right knee
M25.462	Effusion, left knee

Showing 1–10 of 21

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	Commonly used for the physician visit when prescribing or re-evaluating the orthosis and documenting medical necessity
`97760`	Orthotic management and training, initial encounter (eg, fitting and training with orthosis)	Used by therapists or orthotists for patient training and gait/functional training after delivery of the orthosis
`97763`	Orthotic/prosthetic management and training, subsequent encounter	Used for follow-up orthotic management visits to adjust fit and provide additional training
`99070`	Supplies and materials (over and above those usually included with the office visit)	May be used by suppliers to bill for additional consumable items provided with the orthosis (confirm payer rules)
`99456`	Work-related or medical disability examination services (impairment rating)	Occasionally used when an orthosis is provided in the context of workers' compensation functional assessment (use per payer/work comp rules)

Related Modifiers

5 rows

Modifier	Description	When to Use
95	Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…	- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…
55	Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…	- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
3P	The CPT Category II modifier -3P denotes a performance‑measure exclusion when a required quality action was not performed because of system‑level constraints. It is appended only to Category II…	- When to apply: Use CPT Category II modifier 3P only with Category II (‘‘F’’) codes when a specific quality measure’s specifications allow a system‑level exclusion — append 3P to indicate the…
92	Modifier 92 (Alternative Laboratory Platform Testing) is used when laboratory tests are performed with single‑use, disposable, portable kits or transportable instruments. The AMA defines it for tests…	- Use modifier 92 when a laboratory test is performed using a single‑use, disposable analytical device or kit (an alternative laboratory platform) that is portable and may be taken to or near the…
63	Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…	- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
2086S0102X	Surgical Critical Care Physician	A surgeon with expertise in the management of the critically ill and postoperative patient, particularly the trauma victim, who specializes in critica…
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…
363A00000X	Physician Assistant	A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and…
103TM1700X	Deactivated - Psychologist Men & Masculinity
207VC0200X	Critical Care Medicine (Obstetrics & Gynecology) Physician	An obstetrician/gynecologist, who specializes in critical care medicine diagnoses, treats and supports female patients with multiple organ dysfunction…
207RS0012X	Sleep Medicine (Internal Medicine) Physician	An Internist who practices Sleep Medicine is certified in the subspecialty of sleep medicine and specializes in the clinical assessment, physiologic t…
2251G0304X	Geriatric Physical Therapist	A licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Geriatric Physical Therapy, who has d…
293D00000X	Physiological Laboratory	A laboratory that operates independently of a hospital and physician's office to furnish physiological diagnostic services (e.g. EEG's , EKG's, scans,…

Related ICD-10-CM Codes

21 rows

ICD-10-CM Code	Description
M17.0	Bilateral primary osteoarthritis of knee
M17.11	Unilateral primary osteoarthritis, right knee
M17.12	Unilateral primary osteoarthritis, left knee
M17.9	Osteoarthritis of knee, unspecified
M22.2X1	Patellofemoral disorders, right knee
M22.2X2	Patellofemoral disorders, left knee
M23.8X1	Other internal derangements of right knee
M23.8X2	Other internal derangements of left knee
M25.461	Effusion, right knee
M25.462	Effusion, left knee

Showing 1–10 of 21

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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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 Level II L1843: Knee Orthosis, Single Upright with Adjustable Joint

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HCPCS Level II L1843: Knee Orthosis, Single Upright with Adjustable Joint

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

References

HCPCS Level II L1843: Knee Orthosis, Single Upright with Adjustable Joint

Sign up for hcpcs L1843 policy alerts

HCPCS Level II L1843: Knee Orthosis, Single Upright with Adjustable Joint

Sign up for hcpcs L1843 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What does HCPCS code L1843 represent?

Which modifiers are commonly used with L1843 and when should they be applied?

What clinical documentation and workflow are described to support medical necessity for L1843?

Which diagnosis codes are appropriate to pair with L1843 on claims?

What CPT codes are commonly billed alongside L1843 for visits, fitting, or training?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What does HCPCS code L1843 represent?

Which modifiers are commonly used with L1843 and when should they be applied?

What clinical documentation and workflow are described to support medical necessity for L1843?

Which diagnosis codes are appropriate to pair with L1843 on claims?

What CPT codes are commonly billed alongside L1843 for visits, fitting, or training?

References