Question 1

What is HCPCS code L1951?

Accepted Answer

HCPCS code L1951 is "Afo spiral prefab custom". Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Question 2

What category is L1951 in?

Accepted Answer

L1951 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L1951?

Accepted Answer

Use L1951 when billing for afo spiral prefab custom. 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 L1951 covered by Medicare?

Accepted Answer

Coverage for L1951 (Afo spiral prefab custom) 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 L1951?

Accepted Answer

Documentation for L1951 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).