Suggested HCPCS Code: L1906

• Adjustable Velcro closures for perfect fit
• Full flexion ankle joints for ease of or restriction of motion
• Orthotic foot plate supports foot and ankle

Underlying Conditions:

• Ankle/Foot Sprain
• Ankle/Foot Contracture
• Ankle/Foot derangement
• Osteoarthritis

Coverage Criteria: Patient is ambulatory with weakness or deformity of the foot and ankle requiring stabilization for medical reasons and has the potential to benefit functionally from the boot

Suggested HCPCS Code: L1971

• Ambidextrous design fits left or right foot
• Adjustable velcro closures
• Calf and lateral supports
• Full flexion hinge
• Lightweight and easy to adjust
• Moldable foot plate

Underlying Conditions:

• Ankle/Foot Sprain/Fracture
• Ankle/Foot Contracture
• Ankle/Foot derangement
• Osteoarthritis
• Non-traumatic ruptures of tendon

Coverage Criteria: Patient is ambulatory with weakness or deformity of the foot and ankle requiring stabilization for medical reasons and has the potential to benefit functionally from the boot

Suggested HCPCS Code: L1902

• Lightweight breathable construction
• Figure 8 design mimics ankle taping
• Quick-lace design for easy application

Underlying Conditions:

• Ankle Sprain
• Ankle Fracture
• Tendinitis
• Plantar Fascitis

Coverage Criteria: Patient is ambulatory with weakness or deformity of the foot and ankle requiring stabilization for medical reasons and has the potential to benefit functionally

Suggested HCPCS Code: L1930

• Anatomical design compensates for atrophy and avoids calcaneus irritation
• To be used for mild to moderate drop foot
• Thin, flexible foot part can be trimmed with a pair of cast scissors
• Excellent fit for most types of shoes

Underlying Conditions:

• Drop Foot
• Ankle/Foot Contracture
• Ankle/Foot Derangement
• Osteoarthritis

Coverage Criteria: Patient is ambulatory with weakness or deformity of the foot and ankle requiring stabilization for medical reasons and has the potential to benefit functionally from the boot

Suggested HCPCS Code: L1932

• Best choice for patients who pronate (valgus or eversion)
• Lateral Strut spirals to anterior aspect. One piece, continuous strand design
• “Y” proximal, anterior trim line relieves the tibia tuberosity area
• Super-flexible calf band accommodates a wide range of circumferences
• Weight limit: 275 lbs.

Underlying Conditions:

• Drop Foot
• Ankle/Foot Contracture
• Ankle/Foot Derangement
• Osteoarthritis

Coverage Criteria: Patient is ambulatory with weakness or deformity of the foot and ankle requiring stabilization for medical reasons and has the potential to benefit functionally from the boot

Suggested HCPCS Code: L1951

• True Spiral design. Lateral strut spirals to medial aspect.
• Posterior one-piece continuous design.
• Super-flexible calf band accommodates a wide range of circumferences
• Weight limit: 275lbs

Underlying Conditions:

• Drop Foot
• Ankle/Foot Contracture
• Ankle/Foot Derangement
• Osteoarthritis

Coverage Criteria: Patient is ambulatory with weakness or deformity of the foot and ankle requiring stabilization for medical reasons and has the potential to benefit functionally from the boot

Suggested HCPCS Code: L1940, L2330, L2820

• Soft, comfortable molded leather inner shell lining
• Padded with 1/8″ medical-grade foam
• Polypropylene-reinforced foot and ankle
• Metatarsal-length foot plate
• Custom anatomical reliefs

Underlying Conditions:

• PTTD (Posterior Tibial Tendon Dysfunction)
• Talocalcaneal varus or valgus
• Tibialis tendonitis (posterior or anterior)
• Severe pronation or pes planus
• Ankle arthritis or Degenerative Joint Disease (DJD)
• Charcot foot
• Ankle, subtalar or mid-tarsal trauma
• Chronic Achilles tendonitis

Suggested HCPCS Code: L4631

• Thermoplastic shell
• Optional 1/8″ medical grade foam padding

Underlying Conditions:

• Charcot foot

Suggested HCPCS Code: L1960

• Thermoplastic shell
• Metatarsal, sulcus, or full length footplate
• Closure with tibial pad

Underlying Conditions:

• Foot drop
• Weak or absent plantar flexors and/or dorsiflexors
• Severe degenerative arthritis
• Lateral and medial instability of subtalar joint
• Trauma

Suggested HCPCS Code: L1970

• Thermoplastic shell
• Available with Free Motion or Dorsi-Assist ankle joint
• Available with varus or valgus correction
• Metatarsal, sulcus, or full length footplate
• Optional 1/8″ medical-grade foam padding
• Closure with tibial pad

Underlying Conditions:

• Mild Posterior Tibial Tendon Dysfunction (PTTD)
• Mild degenerative arthritis
• Lateral and medial instability of subtalar joint
• Foot drop
• Severe pronation
• Trauma

Suggested HCPCS Code: L1970, L2820

• Custom Balanced Foot Orthotic
• Standard 35mm Heel Cup fits into the bottom of the heel counter of the shoe
• Anatomic Ankle Axis Hinge Placement
• Semi-rigid lower limb supports
• Custom contoured footplate attachment

Underlying Conditions:

• Mild Posterior Tibial Tendon Dysfunction (PTTD)
• Mild degenerative arthritis
• Chronic Ankle Instabilityma