Part 1 of this two-part article dealt with clinical issues surrounding Crow Boots. This second and final installment deals with the reimbursement and coding of this very sophisticated device.
Unlike other custom fabricated AFO, Crow Boot may only be coded with one HCPCS.
From the HCPCS and product coding perspective, Crow Boots are different than other custom fabricated AFO devices. That is because while most custom fabricated AFO have a parent code and additional add-on-codes, Crow Boots typically may be billed only as L4631. Crow boots are required to include these features (many of these otherwise would be separately coded):
- A design to hold the foot in a fixed position of 0 degrees
- Allow for varus or valgus deformity correction
- Contain a rocker sole with custom arch support
- Incorporate a rigid anterior tibial shell
- Used by a patient who is ambulatory
- Has a soft tissue interface
- Totally encapsulates the foot.
From the reimbursement perspective, reimbursement is quite handsome with the DME average fee somewhere near $2,000.
Additionally, L4631 has only a few covered diagnoses, including:
A5216 Charcot arthropathy (tabetic)
E08.610, E09.610, E10.1160 (which are various types of diabetic neuropathic arthropathy), and M14.671 defined as Charcot’s joint, right ankle and foot or M4.672 Charcot’s joint, left ankle and foot.
