Question 1

What is HCPCS code L4396?

Accepted Answer

HCPCS code L4396 is "Static or dynami afo pre cst". Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, 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 L4396 in?

Accepted Answer

L4396 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L4396?

Accepted Answer

Use L4396 when billing for static or dynami afo pre cst. 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 L4396 covered by Medicare?

Accepted Answer

Coverage for L4396 (Static or dynami afo pre cst) 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 L4396?

Accepted Answer

Documentation for L4396 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).