Question 1

What is HCPCS code L4090?

Accepted Answer

HCPCS code L4090 is "Repl met band kafo-afo calf/". Replace metal bands kafo-afo, calf or distal thigh

Question 2

What category is L4090 in?

Accepted Answer

L4090 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L4090?

Accepted Answer

Use L4090 when billing for repl met band kafo-afo calf/. 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 L4090 covered by Medicare?

Accepted Answer

Coverage for L4090 (Repl met band kafo-afo calf/) 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 L4090?

Accepted Answer

Documentation for L4090 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).