ATTACHMENT 6
A
SSISTIVE
T
ECHNOLOGY
B
ILLING
C
ODES
Please monitor the EI website at www.dhs.state.il.us/ei for changes to the Assistive Technology Code Table.
ASSISTIVE TECHNOLOGY BILLING CODES
CODE CODE DESCRIPTION
A4636 Replacement, handgrip, cane, crutch, or walker, each A4637 Replacement, tip, cane, crutch, walker, each
A9300 Exercise equipment, (i.e., therapy ball, roll, bolster, any size) A9900 Computer access, software
A9900 Miscellaneous DME supply, accessory, and/or service component of another HCPCS code (i.e. Weighted vest, any type)
A9900 Switch activated device A9900 Switch, battery adapter A9900 Weighted blanket, any size A9900 Weights, miscellaneous
E0110 Crutches, forearm, includes crutches of various materials, adj or fixed, pair, complete
E0111 Crutch, forearm, includes crutches of various materials, adj or fixed, each, complete
E0130 Walker, rigid pickup, adjustable/fixed, each E0135 Walker, folding (pickup), adj or fixed height E0141 Walker, rigid wheeled without seat
E0142 Rigid walker, wheeled, with seat E0143 Folding walker, wheeled, without seat
E0144 Enclosed, framed folding walker, wheeled with posterior seat E0146 Folding walker, wheeled, with seat
E0153 Platform attachment, forearm crutch, each E0154 Platform attachment, walker, each
E0155 Wheel attachment, rigid pickup walker, per pair E0158 Leg extensions for walker, per set of four (4) E0247
E0248
Tub stool or bench
E1399 Temporary code (feeder seats, positioning chairs)
E1399 AFO, addition, foot/calf strap, each (therapeutic listening programs) E1399 Durable Medical Equipment, NEC
E1399 Posture control seat for floor sitting and feeding, any size E1399 Walker, pelvic stabilizer attachment
E1399 Wedge, floor therapy
E1802 Dynamic adjustable forearm, pronation/supination device, includes soft interface material
E1902 Communication board, non-electronic augmentative or alternative communication device (PECS, eye-comm. board, boardmaker)
K0113 Trunk support device, vest type, without inner frame, prefabricated, Benik, only K0541 Speech generating device, digitized speech, prerecorded messages, <=8 min
CODE CODE DESCRIPTION
K0542 Speech generating device, digitized speech, prerecorded messages, >8 min recording time (Dynavox, Macaw, Step by Step, E-talk)
K0544 Speech generating device, synthesized speech, permitting multi methods of message formation and multi methods of device access
K0546 Accessory for speech generating device, mounting system
K0547 Accessory for speech generating device, NOC (overlay, keyguard) L0120 Collar, flexible, nonadjustable (foam collar)
L0984 Spinal orthosis, protective body sock
L1500 THKAO, mobility frame (Newington, parapodium types) L1510 THKAO, standing frame, with or without tray and accessories L1520 THKAO, swivel walker
L1600 HO, abduction control of hip joints, flexible, Frejka type with cover, prefabricated, F&A
L1610 HO, abduction control of hip joints, flexible, (Frejka cover only), prefabricated, F&A L1620 HO, abduction control of hip joints, semi-flexible, (Pavlik harness), prefabricated,
F&A
L1630 HO, abduction control of hip joints, semi-flexible, (Von Rosen type), custom fabricated
L1640 HO, abduction control of hip joints, static, pelvic band or spreader bar, thigh cuffs, custom fabricated
L1650 HO, abduction control of hip joints, static, adjustable (Ilfled type), prefabricated, F&A
L1660 HO, abduction control of hip joints, static, plastic, prefabricated, F&A
L1680 HO, abduction control of hip joints, dynamic, pelvic control, adjustable hip motion control, thigh cuffs (Ranch hip action type), custom fabricated
L1690 Combination, bilateral, lumbo-sacral, hip, femur orthosis providing adduction and internal rotation control, prefabricated, F&A (SWASH)
L1800 KO, elastic with stays, prefabricated, F&A L1810 KO, elastic with joints, prefabricated, F&A
L1830 KO, immobilizer, canvas longitudinal, prefabricated, F&A
L1860 KO, modification of supracondylar prosthetic socket, custom fabricated L1901 Ankle orthosis, elastic, prefabricated, F&A (e.g., neoprene, lycra) L1902 AFO, ankle gauntlet, prefabricated, F&A
L1904 AFO, molded ankle gauntlet, custom fabricated
L1920 AFO, single upright with static or adjustable stop, custom fabricated L1930 AFO Prefabricated
L1930 AFO, plastic or other material, prefabricated, F&A L1940 AFO, plastic or other material, custom fabricated L1940 SMO
L1945 AFO, molded to patient model, plastic, rigid anterior tibial section (floor reaction), custom fabricated
CODE CODE DESCRIPTION
L1960 AFO, posterior solid ankle, plastic, custom fabricated L1970 AFO, plastic, with ankle joint, custom fabricated
L1980 AFO, single upright free plantar dorsiflexion, solid stirrup, calf band/cuff (single bar "BK" orthosis), custom fabricated
L1990 AFO, double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar "BK" orthosis), custom fabricated
L2000 KAFO, single upright, free knee, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar "AK" orthosis), custom fabricated
L2010 KAFO, single upright, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar "AK" orthosis), without knee joint, custom fabricated
L2020 KAFO, double upright, free knee, free ankle, solid stirrup, thigh and calf bands/cuffs (double bar "AK" orthosis), custom fabricated
L2030 KAFO, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs (double bar "AK" orthosis), without knee joint, custom fabricated
L2035 KAFO, full plastic, static (pediatric size), prefabricated, F&A L2036 KAFO, full plastic, double upright, free knee, custom fabricated L2037 KAFO, full plastic, single upright, free knee, custom fabricated
L2038 KAFO, full plastic, without knee joint, multiaxis ankle, (Lively orthosis or equal), custom fabricated
L2040 HKAFO, torsion control, bilateral rotation straps, pelvic band/belt, custom fabricated
L2050 HKAFO, torsion control, bilateral torsion cables, hip joint, pelvic band/belt, custom fabricated
L2060 HKAFO, torsion control, bilateral torsion cables, ball bearing hip joint, pelvic band/belt, custom fabricated
L2070 HKAFO, torsion control, unilateral rotation straps, pelvic band/belt, custom fabricated
L2080 HKAFO, torsion control, unilateral torsion cable, hip joint, pelvic band/belt, custom fabricated
L2090 HKAFO, torsion control, unilateral torsion cable, ball bearing hip joint, pelvic band/belt, custom fabricated
L2200 Addition to lower extremity, limited ankle motion, each joint
L2210 Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint L2220 Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint L2230 Addition to lower extremity, split flat caliper stirrups and plate attachment
L2240 Addition to lower extremity round caliper and plate attachment
L2250 Addition to lower extremity, foot plate, molded to patient model, stirrup attachment L2260 Addition to lower extremity, reinforced solid stirrup
L2265 Addition to lower extremity, long tongue stirrup
L2270 Addition to lower extremity, varus/valgus correction ("t") strap, padded/lined or malleolus pad
L2275 Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined
L2280 Addition to lower extremity, molded inner boot
CODE CODE DESCRIPTION
L2310 Addition to lower extremity, abduction bar, straight L2320 Addition to lower extremity, nonmolded lacer
L2330 Addition to lower extremity, lacer molded to patient model L2335 Addition to lower extremity, anterior swing band
L2340 Addition to lower extremity, pretibial shell, molded to patient model
L2350 Addition to lower extremity, prosthetic type, (BK) socket, molded to patient model, (used for "PTB," "AFO" orthosis)
L2360 Addition to lower extremity, extended steel shank L2370 Addition to lower extremity, Patten bottom
L2375 Addition to lower extremity, torsion control, ankle joint and half solid stirrup L2380 Addition to lower extremity, torsion control, straight knee joint, each joint L2405 Addition to knee joint, drop lock, each joint
L2415 Addition to knee lock with integrated release mechanism (ball, cable, or equal), any material, each joint
L2425 Addition to knee joint, disc or dial lock for adjustable knee flexion, each joint L2430 Addition to knee joint, ratchet lock for active and progressive knee extension, each
joint
L2435 Addition to knee joint, polycentric joint, each joint L2580 Addition to lower extremity, pelvic control, pelvic sling
L2600 Addition to lower extremity, pelvic control, hip joint, Clevis type, or thrust bearing, free, each
L2622 Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each L2624 Addition to lower extremity, pelvic control, hip joint, adjustable flexion, extension,
abduction control, each
L2627 Addition to lower extremity, pelvic control, plastic, molded to patient model, reciprocating hip joint and cables
L2628 Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables
L2630 Addition to lower extremity, pelvic control, band and belt, unilateral L2640 Addition to lower extremity, pelvic control, band and belt, bilateral
L2650 Addition to lower extremity, pelvic and thoracic control, gluteal pad, each L2660 Addition to lower extremity, thoracic control, thoracic band
L2670 Addition to lower extremity, thoracic control, paraspinal uprights L2680 Addition to lower extremity, thoracic control, lateral support uprights
L2760 Addition to lower extremity orthosis, extension, per extension, per bar (for lineal adjustment for growth)
L2768 Orthotic side bar disconnect device, per bar
L2770 Addition to lower extremity orthosis, any material, per bar or joint L2785 Addition to lower extremity orthosis, drop lock retainer, each L2795 Addition to lower extremity orthosis, knee control, full kneecap
L2800 Addition to lower extremity orthosis, knee control, kneecap, medial or lateral pull L2810 Addition to lower extremity orthosis, knee control, condylar pad
CODE CODE DESCRIPTION
L2820 Addition to lower extremity orthosis, soft interface for molded plastic, below knee section
L2830 Addition to lower extremity orthosis, soft interface for molded plastic, above knee section
L2860 Addition to lower extremity joint, knee or ankle, concentric adjustable torsion style mechanism, each
L2999 Lower extremity orthosis, NOS
L3000 Foot insert, removable molded to patient model, "UCB" type, berkely shell, each L3001 Foot insert, removable, molded to patient, Spenco, each
L3002 Foot insert, removable, molded to patient model, Plastazote or equal, each L3003 Foot insert, removable, molded to patient model, silicone gel, each
L3010 Foot insert, removable, molded to patient model, longitudinal arch support, each L3020 Foot insert, removable, molded to patient model, longitudinal/metatarsal support,
each
L3030 Foot insert, removable, formed to patient foot, each
L3040 Foot, arch support, removable, premolded, longitudinal, ea L3050 Foot, arch support, removable, premolded, metatarsal, each
L3060 Foot, arch support, removable, premolded, longitudinal/metatarsal, each L3070 Foot, arch support, nonremovable, attached to shoe, longitudinal, each L3080 Foot, arch support, nonremovable, attached to shoe, metatarsal, each
L3090 Foot, arch support, nonremovable, attached to shoe, longitudinal/metatarsal, each L3140 Foot, abduction rotation bar, including shoes
L3150 Foot, abduction rotation bar, without shoes L3170 Foot, plastic heel stabilizer
L3201 Orthopedic shoe, oxford with supinator or pronator, infant L3202 Orthopedic shoe, oxford with supinator or pronator, child L3204 Orthopedic shoe, hightop with supinator or pronator, infant L3206 Orthopedic shoe, hightop with supinator or pronator, child L3212 Benesch boot, pair infant
L3213 Benesch boot, pair child
L3257 Orthopedic footwear, additional charge for split size L3300 Lift, elevation, heel tapered to metatarsals, per inch L3310 Lift, elevation, heel and sole, neoprene, per inch L3320 Lift, elevation, heel and sole, cork, per inch
L3332 Lift, elevation, inside shoe, tapered, up to one-half inch L3350 Heel wedge
L3380 Clubfoot wedge
L3580 Orthopedic shoe addition, convert instep to velcro closure L3700 EO, elastic with stays, prefabricated, F&A
CODE CODE DESCRIPTION
L3710 EO, elastic with metal joints, prefabricated F&A
L3720 EO, double upright with forearm/arm cuffs, free motion, custom fabricated L3730 EO, double upright with forearm/arm cuffs, extension/flexion assist, custom
fabricated
L3740 EO, double upright with forearm/arm cuffs, free motion, custom fabricated L3760 Elbow orthosis, with adjustable position locking joint(s), prefabricated, F&A, any
type
L3762 Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, F&A
L3800 WHFO, short opponens, no attachments, custom fabricated L3805 WHFO, long opponens, no attachments, custom fabricated L3807 WHFO, without joints, prefabricated, F&A, any type
L3810 WHFO, addition to short and long opponens, thumb abduction ("C") bar
L3890 Addition to upper extremity joint, wrist or elbw, concentric adjustable torsion style mechanism, each
L3906 WHO, wrist gauntlet, molded to patient model, custom fabricated
L3907 WHFO, wrist gauntlet with thumb spica, molded to patient model, custom fabricated L3908 WHO, wrist extension control cock-up, non-molded, prefabricated, F&A
L3909 Wrist orthosis, elastic, prefabricated, F&A (e.g., neoprene, Lycra
L3911 Wrist hand finger orthosis, elastic, prefabricated, F&A (e.g., neoprene, Lycra) L3912 HFO, flexion glove with elastic finger control, prefabricated, F&A
L3914 WHO, wrist extension cock-up, prefabricated, F&A L3923 HFO, without joints, prefabricated, F&A
L3936 WHFO, Palmer, prefabricated, F&A L3938 WHFO, dorsal wrist, prefabricated, F&A
L3946 HFO, composite+F164 elastic, prefabricated, F&A
L3956 Addition of joint to upper extremity orthosis, any material; per joint L3999 Upper limb orthosis, NOS
L4210 Repair of orthotic device, repair or replace minor parts L4392 Replacement soft interface material, static AFO
Q4051 Splint supplies, miscellaneous (includes thermoplastics, strapping, fasteners, padding, and other supplies
S5199 Adaptive, utensil, feeding S5199 Adaptive, cup, nosey
S5199 Personal care item, NOS, each S8470 Stander, positioning device V5014 Hearing aid, repairs, over $100 V5014 Repair/modification of a hearing aid V5060 Hearing aid, monaural, behind the ear V5140 Hearing aid, binaural, behind the ear
CODE CODE DESCRIPTION
V5150 Hearing aid, binaural, glasses V5160 Hearing aid dispensing fee, binaural V5241 Hearing aid dispensing fee, monaural V5267 Hearing aid, pediatric care kit
V5264 Hearing aid ear mold/insert, not disposable, any type V5266 Battery for use in hearing aid
V5266 Hearing aid, battery, silver, any size, each V5267 Hearing aid supplies/accessories
V5267 Hearing aid, alligator clip V5267 Hearing aid, Replacement cord