Summary & Overview
HCPCS L1845: Knee Orthosis, Double-Upright, Adjustable Joint
HCPCS Level II code L1845 designates a prefabricated, customized double-upright knee orthosis with adjustable flexion/extension joints and medial-lateral/rotational control. The code captures provision of a mechanically robust orthotic device that is trimmed or otherwise customized by a skilled practitioner to fit an individual patient. Nationally, this code matters because it represents a common category of durable medical equipment used for conditions that require advanced knee stabilization, influencing coverage decisions, supplier processes, and cost management across payers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for use of the device, typical sites of service, and what to expect in billing practice. The publication summarizes common modifiers and billing considerations, payer coverage patterns where available, and related coding that may affect claim adjudication. It also reviews benchmarks and policy developments relevant to orthotic DME billing and highlights areas where documentation and supplier customization are central to claim acceptance.
This executive summary prepares clinicians, billing professionals, and policy analysts to understand how L1845 maps to clinical need, where it is typically supplied, and which payers commonly adjudicate claims for such advanced knee orthoses. Data not available in the input is noted as such in detailed sections.
Billing Code Overview
HCPCS Level II code L1845 describes a knee orthosis, 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, provided as a prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise. This device is used to provide significant mechanical support and stabilizing control for the knee joint, addressing conditions that require adjustable control of flexion/extension and medial-lateral alignment.
Service type: Durable medical equipment / orthotic device provision and customization
Typical site of service: Outpatient orthotics/prosthetics clinics, durable medical equipment suppliers, inpatient rehabilitation settings, and hospital outpatient departments
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with symptomatic osteoarthritis of the knee and recurrent mediolateral instability is referred to an orthopedic specialist and a certified orthotist. After clinical evaluation and imaging, the patient is fitted with a prefabricated custom-trimmed knee orthosis: a double upright, thigh-and-calf orthosis with an adjustable flexion-extension joint that provides medial-lateral and rotational control. The workflow includes: orthopedist evaluation and order; measurements and trial fitting by a licensed orthotist; in‑office trimming, bending, and joint adjustment to the patient’s anatomy and prescribed range-of-motion limits; patient education on donning/doffing and skin checks; and follow-up visits for fit verification and any mechanical adjustments. Typical documentation includes the orthotist’s measurement and customization notes, the prescriber’s order and diagnosis, functional goals, and any repair or replacement plans.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | When orthosis is supplied for the left knee |
RT | Right side | When orthosis is supplied for the right knee |