Does L2210 require prior authorization?

No, L2210 does not require prior authorization (high confidence). Code is covered without prior authorization.

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`L2210`, Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

A Standard Written Order (SWO) must be received by the supplier before a claim is submitted; claims billed without a completed SWO will be denied.
For DMEPOS base items that require a Written Order Prior to Delivery (WOPD), the supplier must have a signed SWO/WOPD before delivery; delivery without a WOPD will result in claim denial.
For base items with separately billed options/accessories/supplies, the WOPD must list the base item (and may list associated items); separate billing for accessories without a WOPD listing the base item will be denied.

Key Coverage Criteria

An item is covered only if it is in a Medicare benefit category, is reasonable and necessary for diagnosis/treatment or to improve functioning of a malformed body member, and meets all other Medicare statutory and regulatory requirements.
Static or dynamic positioning AFOs (L4396 or L4397) not used during ambulation are covered when all of the following are met: plantar-flexion contracture with passive dorsiflexion >= 10 degrees (nonfixed), reasonable expectation contracture can be corrected, contracture significantly interferes or is expected to interfere with function, and device is used as a component of a therapy program including active stretching.
Static or dynamic positioning AFOs (L4396 or L4397) not used during ambulation are covered for beneficiaries with plantar fasciitis.
AFOs described by codes (e.g., L1900, L1902, L1904, L1906, L1907, L1910, L1920, L1930, L1932, L1933, L1940, L1945, L1950, L1951, L1952, L1960, L1970, L1971, L1980, L1990, L2106, L2108, L2112, L2114, L2116, L4350, L4360, L4361, L4386, L4387, L4631) are covered for ambulatory beneficiaries with weakness or deformity of the foot/ankle who require stabilization for medical reasons and have potential to benefit functionally.
KAFOs described by codes (e.g., L2000, L2005, L2010, L2020, L2030, L2034-L2038, L2126, L2128, L2132, L2134, L2136, L4370) are covered for ambulatory beneficiaries who meet AFO criteria and additionally require knee stability.
Custom-fabricated AFOs/KAFOs are covered for ambulatory beneficiaries who meet basic coverage criteria and meet at least one of: cannot be fit with a prefabricated AFO; condition expected to be permanent or >6 months; need to control knee/ankle/foot in more than one plane; documented neurological/circulatory/orthopedic status requiring custom fabrication to prevent tissue injury; or a healing fracture lacking normal anatomical integrity or anthropometric proportions.

`L2210`, Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each

Prior Authorization

Documentation Required

Key Coverage Criteria

2 Active Policies

Related Codes

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L2210, Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each

Prior Authorization

Documentation Required

Key Coverage Criteria

2 Active Policies

Related Codes

Have a follow-up question?

`L2210`, Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each