Summary & Overview
HCPCS L4080: Replace Metal Bands KAFO, Proximal Thigh
HCPCS Level II code L4080 covers the replacement of metal bands on a knee-ankle-foot orthosis (KAFO) at the proximal thigh. This orthotic component service matters nationally because KAFOs are critical for mobility, fall prevention, and rehabilitation; timely component replacement preserves device function, patient safety, and continuity of care. Payers frequently evaluate coverage and reimbursement of orthotic repairs and component replacements as cost-control and quality measures.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines typical coverage considerations across these payers, common billing practices, and how L4080 fits within durable medical equipment and orthotics service lines.
Readers will learn the clinical and billing context for L4080, expected sites of service, and how this code is used in practice for orthotic maintenance. The report provides benchmarks for utilization and reimbursement where available, summarizes relevant policy updates affecting orthotics component replacement, and clarifies documentation elements typically associated with coverage reviews. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code L4080 describes the replacement of metal bands on a knee-ankle-foot orthosis (KAFO) at the proximal thigh. The service involves replacing metal band components that secure a KAFO around the proximal thigh to restore fit, function, and safety of the orthotic device.
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Service type: Orthotic component replacement and adjustment
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Typical site of service: Durable medical equipment supplier location, orthotics/prosthetics clinic, or outpatient rehabilitation setting
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 14-year-old adolescent with spastic diplegic cerebral palsy attends an orthotics clinic for a scheduled replacement of the proximal-thigh metal bands on a long knee–ankle–foot orthosis (KAFO). The existing KAFO shows metal band fatigue and loosening at the proximal thigh junction that causes rubbing, reduced control of frontal-plane stability, and patient discomfort. The orthotist evaluates the device, documents wear to the proximal thigh metal bands and intact condition of the remainder of the KAFO, obtains updated measures, and orders replacement metal bands. On the day of service the patient presents to the outpatient orthotics workshop; the orthotist removes the old proximal thigh metal bands, fits and secures the replacement metal bands to the existing KAFO shell, checks alignment and strap placement, makes minor adjustments for comfort, and provides patient/caregiver education on donning, doffing, and skin checks. Typical sites of service: outpatient orthotics/prosthetics clinic, hospital outpatient department, ambulatory surgery center when device adjustment is combined with a procedure, or a skilled nursing facility for bedside orthotic servicing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct procedural service | Data not available in the input. |
22 |