Question 1

What is HCPCS code L4631?

Accepted Answer

HCPCS code L4631 is "Afo, walk boot type, cus fab". Ankle foot orthosis, walking boot type, varus/valgus correction, rocker bottom, anterior tibial shell, soft interface, custom arch support, plastic or other material, includes straps and closures, custom fabricated

Question 2

What category is L4631 in?

Accepted Answer

L4631 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L4631?

Accepted Answer

Use L4631 when billing for afo, walk boot type, cus fab. 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 L4631 covered by Medicare?

Accepted Answer

Coverage for L4631 (Afo, walk boot type, cus fab) 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 L4631?

Accepted Answer

Documentation for L4631 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).