Summary & Overview
HCPCS L1847: Prefabricated Double-Upright Knee Orthosis with Air Support
HCPCS Level II code L1847 denotes a prefabricated knee orthosis featuring double uprights, an adjustable joint, and inflatable air support chamber(s) that has been customized to fit a specific patient. The code captures provision and patient-specific customization of a pneumatic-support knee orthosis commonly used for stabilization, adjustable offloading, and dynamic support in ambulatory care. Nationally, accurate coding for such orthoses affects durable medical equipment coverage, prior authorization workflows, and patient access to bespoke support devices.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context on the device purpose and typical settings for fitting, a summary of payer coverage patterns where available, and the practical implications for billing and documentation. The publication highlights benchmarks for utilization and common administrative considerations, summarizes relevant modifier and claim-handling notes provided in the input, and points to where to look for payer-specific policy language.
This briefing is designed for billing professionals, orthotists, and policy analysts seeking a concise reference to the clinical intent and billing context of L1847, and to support accurate claim submission and coverage verification at a national level.
Billing Code Overview
HCPCS Level II code L1847 describes a prefabricated knee orthosis with double uprights and an adjustable joint that includes inflatable air support chamber(s). The item is provided as a prefabricated product that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise. The device is intended to provide knee stabilization and adjustable support with pneumatic/air components integrated into the orthosis.
Service Type: Orthotic device provision and customization
Typical Site of Service: Outpatient clinic, orthotics/prosthetics facility, or other ambulatory setting where orthotic fitting and customization are performed
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with advanced medial compartment knee osteoarthritis and intermittent joint effusion presents to an orthopedics clinic for conservative management. The orthotist evaluates the patient and documents varus thrust and pain with ambulation. A prefabricated double upright knee orthosis with adjustable joint and inflatable air support chambers (L1847) is selected to provide coronal plane stability and adjustable pneumatic offloading. The device is trimmed, bent, and custom-fit by the orthotist in the clinic, with patient education on donning, inflation adjustments, skin checks, and documented functional outcome goals. The workflow includes: initial evaluation and measurement by the orthotist; physician order and medical necessity documentation tied to the patient’s knee diagnosis; device selection and customization session; trial wear and immediate adjustments; delivery note with measurable functional improvements; and follow-up visits for device reassessment and adjustment as needed. Typical sites of service include outpatient orthotics/prosthetics clinics, orthopedic or sports medicine offices, and freestanding durable medical equipment provider clinics.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier | Standard reporting when no special condition applies |