Flexion Contracture ROM Air Knee Brace
Suggested HCPCS Code: L1831
- X strap for complete knee range of motion
- Air technology uses 2 air bladders at the back of the leg to redistribute skin pressure
- Bilateral hinged uprights work with the air bladders to continue to move the joint toward normal alignment
- Hinges can be removed for the most severe flexion contracture and added as the range improves
- Soft, breathable fabric helps keep the patient’s leg cool and dry
| Product Number | Side | Size | Thigh Circ. | Calf Circ. |
| 11-0700 | Right | Small | 10″-15″ | 8″-12″ |
| 11-0701 | Left | Small | 10″-15″ | 8″-12″ |
| 11-0702 | Right | Medium | 13″-17″ | 10″-15″ |
| 11-0703 | Left | Medium | 13″-17″ | 10″-15″ |
| 11-0704 | Right | Large | 17″-22″ | 12″-17″ |
| 11-705 | Left | Large | 17″-22″ | 12″-17″ |
Underlying Conditions:
- Knee Contracture
Coverage Criteria:
- Patient has flexion or extension contractures of the knee with movement on passive range of motion testing of at least 10 degrees
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.
