Customized vs. Off The Shelf Codes

Why do the braces you purchase have two codes on the sticker
and which one should you be using?

In January 2014, Medicare assigned a SECOND code to many
types of braces. Over the following months, commercial carriers
as well as Workers Comp and PI followed suit and picked up the
new codes.

The original code for many of these braces became a

"customized code"

and the second (newer) code was added as an

"off the shelf code (OTS)."

So which code should you bill with?

In using the customized code, one would have to be certain that
they have customized the brace for the patient. If the brace was
not customized, then the Off The Shelf (OTS) code would be the
correct billing code for the item.

More often than not, you would be correct in billing
the OFF THE SHELF code.
Here is what the Policy States:

OTS Codes: L0648, L0650, L1851

OTS orthotics are those orthotics which require minimal self-
adjustment for appropriate use and do not require expertise in
trimming, bending, molding, assembling, or customizing to fit to
the individual.

CMS regulations define the term “minimal self-adjustment” to
mean an adjustment that the beneficiary, caretaker for the
beneficiary, or supplier of the device can perform and that does
not require the services of a certified orthotist (that is, an
individual who is certified by the American Board for Certification
in Orthotics and Prosthetics, Inc., or by the Board for
Orthotist/Prosthetist Certification) or an individual who has
specialized training in the provision of customized orthosis.

Azon Medical is here to assist you in remaining compliant with
your DME. If you feel you may not be using a correct code, have
any further questions on billing or coding your DME products, or
need to place an order-- contact your Azon DME Representative

For assistance with your bracing program or to place an order,
contact us at Azon Medical:
For more information, contact:
Jodi Dastur
(727) 273-7080

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