Posterior Night Splint

Suggested HCPCS Code: L4396/L4397

Product Number Side Size Shoe Size
17-0300 Small W: <7 M:<6.5
17-0301 Medium W: 7.5-10 M: 6.5-9.5
17-0302 Large W: 10+ M: 9.5+
Underlying Conditions:
  • Plantar Fascial Fibromatosis
  • Contracture of Ankle
  • Contracture of Foot

Coverage Criteria: (Patient must meet one of the following criteria)

  • Plantar Fasciitis
  • Or all of the following:
  • Plantar flexion contracture of the ankle with dorsiflexion on passive range of motion testing (using Goniometer) of at least 10 degrees.
  • Reasonable expectation of the ability to correct the contracture
  • Contracture is interfering/expected to interfere significantly with functional abilities
  • Splint is used as part of therapy program including active stretching of the involved muscles/tendons

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Our Process is as follows: