Question 1

What is HCPCS code L1831?

Accepted Answer

HCPCS code L1831 is "Knee orth pos locking joint". Knee orthosis, locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment

Question 2

What category is L1831 in?

Accepted Answer

L1831 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L1831?

Accepted Answer

Use L1831 when billing for knee orth pos locking joint. 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 L1831 covered by Medicare?

Accepted Answer

Coverage for L1831 (Knee orth pos locking joint) 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 L1831?

Accepted Answer

Documentation for L1831 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).