Summary & Overview
HCPCS L2136: KAFO for Femoral Fracture, Rigid Prefabricated
HCPCS Level II code L2136 designates a prefabricated, rigid knee-ankle-foot orthosis (KAFO) used as a femoral fracture cast orthosis, inclusive of fitting and adjustment. This code captures a commonly used orthotic intervention for immobilization and support after femoral fractures, representing an important category of durable medical equipment with implications for post-acute orthopedic care and functional recovery. Nationally, orthotic device billing affects utilization patterns, coverage determinations, and care pathways 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 the clinical context for L2136, typical sites of service, and the scope of services bundled with the code. The publication summarizes common payer considerations and benchmarks where available, notes policy update areas relevant to orthotic coverage, and outlines practical billing elements associated with device provision and fitting. Data not available in the input is identified where applicable. This resource is intended to clarify what HCPCS Level II code L2136 represents and what stakeholders can expect when this orthosis is billed in the outpatient orthotics and orthopedic care settings.
Billing Code Overview
HCPCS Level II code L2136 describes a KAFO, fracture orthosis, femoral fracture cast orthosis, rigid, prefabricated, includes fitting and adjustment. This device is a prefabricated, rigid knee-ankle-foot orthosis designed to immobilize and support the femur and associated lower-extremity structures following a femoral fracture. The service type is durable medical equipment/prosthetic and orthotic device provision, including fitting and adjustment as part of the billed service.
The typical site of service for provision and fitting is outpatient orthotics/prosthetics clinics, hospital-based orthotics departments, or specialty orthopedic clinics where orthotists and technicians perform fitting and adjustments.
Clinical & Coding Specifications
Clinical Context
A 42-year-old male presents to an outpatient orthopedic clinic after a low-energy fall resulting in a mid-shaft femoral fracture that is stable and amenable to nonoperative management. Imaging confirms a nondisplaced to minimally displaced femoral shaft fracture. The orthopedic surgeon orders a prefabricated rigid femoral fracture cast orthosis (KAFO) to immobilize the femur and hip, provide weight-bearing protection, and allow controlled mobilization.
The clinical workflow: initial evaluation and radiographs in clinic or emergency department; diagnosis documentation with appropriate ICD-10 fracture code on the encounter note; order placed for a prefabricated rigid KAFO described by billing code L2136; orthotics technician performs sizing, fitting, and in-office adjustments during the same visit or a scheduled orthotics visit; instructions for skin care, activity limitations, and follow-up radiographs are documented. Subsequent visits document fit checks, modifications, and progression of weight-bearing as clinically indicated. Billing includes the orthosis code L2136 with any applicable modifier(s) and the attending provider taxonomy and diagnosis codes on the claim.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side |