ACL Knee Brace
Suggested HCPCS Code: L1845/L1852
- Sleek, low profile design
- Durable, lightweight aluminum construction
- Flexion (45°, 60°, 75°, 90°) and extension (0°, 10°, 20°, 30°, 40°) stops
| Product Number | Side | Size | Circ 6″ Above Knee Center |
| 11-1200 | Right | Small | 15.5″-18.5″ |
| 11-1201 | Left | Small | 15.5″-18.5″ |
| 11-1202 | Right | Medium | 18.5″-21″ |
| 11-1203 | Left | Medium | 18.5″-21″ |
| 11-1204 | Right | Large | 21″-23.5″ |
| 11-1205 | Left | Large | 21″-23.5″ |
| 11-1206 | Right | X-Large | 23.5″-26.5″ |
| 11-1207 | Left | X-Large | 23.5″-26.5″ |
Underlying Conditions:
- ACL Tear
- Congenital Deformity of Knee Joint
- Chondromalacia of Patella
- Old Bucket Handle of Medial Meniscus
- Pathologic Fracture of Femur/Tibia/Fibula
- Rheumatoid Arthritis
- Osteoarthritis
Coverage Criteria:
Patient must meet one of the following criteria)
- Recent knee injury or Recent surgical procedure on knee
- Patient is ambulatory and has knee instability due to diagnosisstabilization
Our Process is as follows:
- 1. Choose a brace, send a brace request form and a facesheet to our office.
- 2. PME will verify insurance coverage, prepare a script and send it to the requester for a DR signature.
- 3. Facility sends back signed script
- 4. PME ships brace to the facility.
