Summary & Overview
HCPCS L1852: Knee Orthosis, Double Upright, Prefabricated Off-the-Shelf
HCPCS Level II code L1852 represents a prefabricated, off-the-shelf knee orthosis with dual uprights and an adjustable flexion/extension joint that provides medial-lateral and rotational control, and optional varus/valgus adjustment. This orthosis is used to stabilize the knee across thigh and calf segments, support controlled range of motion, and manage alignment in a range of post-operative, degenerative, and injury-related conditions. Nationally, such orthoses are a common durable medical equipment (DME) service with implications for rehabilitation outcomes, functional mobility, and cost of care for knee-related conditions.
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, typical sites of service, and the service type tied to L1852. The publication also summarizes payer coverage patterns, common modifiers encountered in billing, and how L1852 relates to orthotic device provisioning and outpatient DME workflows.
This piece provides practical benchmarks and policy-relevant notes for payers and providers: billing and coding considerations for a prefabricated, adjustable, double-upright knee orthosis; expected settings where the device is dispensed and fitted; and where to find further guidance. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code L1852 describes a knee orthosis (KO), 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, prefabricated, off-the-shelf. This device is a prefabricated, off-the-shelf knee brace featuring dual uprights that span the thigh and calf and an adjustable joint to control flexion, extension, medial-lateral stability, rotation, and optional varus/valgus alignment.
Service type: Orthotic device provision and fitting
Typical site of service: Outpatient durable medical equipment (DME) setting, orthotics clinic, or outpatient rehabilitation facility
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old male with symptomatic medial compartment osteoarthritis and intermittent knee instability presents to an orthopedic clinic after conservative therapy (NSAIDs, physical therapy) provided incomplete relief. The clinician evaluates gait, range of motion, ligament stability, and orders weight-bearing radiographs. To reduce pain, improve joint alignment, and control medial-lateral and rotational instability during activities of daily living, the clinician prescribes a prefabricated double-upright knee orthosis with adjustable flexion-extension hinges (L1852). A certified orthotist measures the thigh and calf, fits an off-the-shelf double-upright orthosis, adjusts the unicentric/polycentric hinge settings for desired flexion/extension limits and medial-lateral control, and instructs the patient on donning, skin checks, activity precautions, and follow-up. Typical follow-up occurs within 2–6 weeks for fit checks and later as clinically indicated for adjustments or replacement.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | When the orthosis is provided for the left knee |
RT |