Question 1

What is HCPCS code L1821?

Accepted Answer

HCPCS code L1821 is "Ko elas w/ condyle pads otf". Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, off the shelf

Question 2

What category is L1821 in?

Accepted Answer

L1821 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L1821?

Accepted Answer

Use L1821 when billing for ko elas w/ condyle pads otf. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is L1821 covered by Medicare?

Accepted Answer

Coverage for L1821 (Ko elas w/ condyle pads otf) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for L1821?

Accepted Answer

Documentation for L1821 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).