Documents To be used for reference only... INFORMATION: HCPC billing-Custom Fabricated vs. Pre-Fabricated ICD-10 for TENS and Conductive Garment ICD-10 for Spinal Orthoses ICD-10 for Knee Orthoses FORMS: Proof of Delivery Form LH DME Back Brace Delivery Ticket ASSIGNMENT OF BENEFITS LH DME Patient Packet LETTERS OF MEDICAL NECESSITY TENS: Medicare TENS TENS Unit/Garment (E0730/E0731) Conductive Garment TRUNK: Multipost Therapy Collar (L0180) Cervical Traction Theratrak (E0849) LSO/TLSO LSO/TLSO with Custom Fit Options LSO (L0631) LSO (L0637) Scoliosis Brace (L1005) LOWER EXTREMITIES: Knee Brace Knee Brace (L1812) Knee Brace (L1830) Knee Brace (L1832) Knee Brace (L1833) Knee Brace (L1843) Knee Brace (L1845) Knee Brace (L1851) Knee Brace (L1852) Knee (L2397/2795) Ankle Brace (L1902) Ankle Brace (L1971) UPPER EXTREMITIES: Elbow Brace (L3761) WHFO (L3807) WHFO (L3809)
