HCPCS code L1652: Hip orthosis with bilateral thigh cuffs and spreader bar

HCPCS code L1652 is the billing code for a hip orthosis with bilateral thigh cuffs and an adjustable abductor spreader bar, adult size, prefabricated, including fitting and adjustment of any type. Orthotists and DME suppliers billing Medicare for this device need to clear three distinct hurdles before a claim pays: PDAC product approval, a valid physician order with a certificate of medical necessity, and correct code selection against the closely related L1820. Miss any one and the claim denies.

This guide covers every billing requirement for HCPCS code L1652, including how it differs from L1820 and what documentation survives a Medicare audit.

Found our content helpful?

Key Takeaways

HCPCS code L1652 describes a prefabricated bilateral hip orthosis with adjustable abductor spreader bar, adult size, fitting included.

L1652 is covered under the Medicare DMEPOS benefit and priced on the CMS DMEPOS fee schedule, which varies by locality.

The device billed under L1652 must appear on the PDAC verified product list before submitting any Medicare claim.

Pabau’s claims management software lets DME practices attach L-codes at the point of care and track claim status through to payment.

HCPCS code L1652: Full description and code details

HCPCS code L1652 covers a specific configuration of prefabricated hip orthosis. The full official descriptor, as published in the CMS HCPCS Level II code set, reads: Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, includes fitting and adjustment, any type. The short descriptor used on claim forms is: HO bi thighcuffs w sprdr bar.

Three descriptors within that definition carry billing weight. Bilateral means both thighs are cuffed, not just one. Adjustable abductor spreader bar refers to the connecting mechanism that controls hip abduction angle. Prefabricated means the device is manufactured to standard sizes rather than custom-fabricated from a patient impression. Fitting and adjustment are bundled into the code, so billing them separately results in a duplicate-service denial.

Medicare coverage and DMEPOS pricing for L1652

HCPCS code L1652 is covered under the Medicare Part B DMEPOS benefit when medical necessity is established and the product meets PDAC approval criteria. Medicare pays 80% of the fee schedule allowable after the deductible; the beneficiary or a secondary insurer covers the remaining 20%. Payment amounts are locality-adjusted using the CMS annual HCPCS code list and fee schedule files. Because amounts change each January 1 with the annual DMEPOS update, always pull the current fee schedule from the CMS DMEPOS fee schedule lookup before submitting a claim or setting patient expectations.

Effective revenue cycle management for DMEPOS claims starts with verifying the correct allowable before ordering. Practices billing L1652 without confirming the locality-adjusted rate routinely under-collect because they quote the national average rather than the applicable MAC jurisdiction amount.

• Assigned billing: Medicare pays the supplier directly; the beneficiary pays the 20% coinsurance.
• Rental vs. purchase: L1652 is billed as a purchase, not capped rental.
• Competitive bidding: Check whether L1652 falls under a DMEPOS competitive bidding program contract in the beneficiary’s zip code. Contracted suppliers must be used when competitive bidding applies.
• Advance beneficiary notice (ABN): If medical necessity may not be met, obtain a signed ABN before delivering the device.

PDAC approval and medical necessity requirements for L1652

PDAC approval is a hard prerequisite for billing HCPCS code L1652 to Medicare. The Pricing, Data Analysis and Coding (PDAC) contractor reviews specific products submitted by manufacturers against the code descriptor and publishes a verified product list for orthotic HCPCS codes. A product that is not on this list is not billable under L1652, regardless of how closely it matches the physical description.

This creates a practical workflow step that many smaller DME suppliers skip: Confirm the manufacturer’s model number appears on the PDAC verified list before ordering the device for the patient. Confirming after delivery leaves you with a device you cannot bill. Maintaining medical billing compliance for DMEPOS requires embedding the PDAC verification step into the pre-authorization workflow, not treating it as a post-delivery paperwork check.

• Verify the product model number against the PDAC approved product list before ordering.
• Retain the manufacturer’s PDAC confirmation letter or the PDAC product listing printout in the patient file.
• If the prescribing physician specifies a brand that is not PDAC-approved for L1652, contact the physician to discuss an approved alternative before proceeding.

Documentation requirements for billing L1652

The certificate of medical necessity (CMN) for orthoses is the central documentation requirement for HCPCS code L1652. Medicare DME MACs require the CMN to be completed, signed, and dated by the treating physician before the device is delivered. A CMN completed after delivery does not satisfy the “before delivery” rule and the claim will deny on audit.

Beyond the CMN, a complete L1652 documentation package includes the following. Use this as a pre-claim audit checklist. Good structured medical documentation practices at the point of care prevent the most common post-payment audit findings.

• Physician order / prescription: Written order specifying the bilateral hip orthosis with abductor spreader bar, patient name, date of order, and physician signature.
• Certificate of medical necessity (CMN): Completed and signed by the treating physician before device delivery. Must document the qualifying diagnosis and functional limitations.
• Clinical notes supporting medical necessity: Physician or therapist notes describing the patient’s diagnosis, functional deficits, and why a bilateral configuration with abductor bar is required rather than a simpler device.
• Qualifying ICD-10-CM diagnosis codes: The diagnosis codes on the claim must match the condition documented in the physician notes. Common examples include hip dysplasia, avascular necrosis, or post-surgical hip stabilization requirements.
• Proof of delivery: Signed delivery confirmation from the beneficiary or authorized representative, documenting the device serial number or model number.
• PDAC product confirmation: Documentation that the specific model billed is on the PDAC verified product list for L1652.

The superbill documentation for DMEPOS claims should include the HCPCS code, the PDAC-approved product model, the ICD-10-CM codes, the place of service, and the rendering provider NPI. Missing any of these fields on the claim form triggers an automatic edit that delays or denies payment.

Streamline your DMEPOS billing workflow

Pabau lets your team attach HCPCS L-codes at the point of care, track CMN status, and submit clean claims without switching between systems. See how it works for DME and orthotic practices.

Book a demo

L1652 vs L1820: Choosing the right HCPCS code

L1820 is the most common code confused with HCPCS code L1652, and the distinction matters because selecting the wrong code causes an outright denial rather than a simple correction request. L1652 covers a bilateral configuration with an adjustable abductor spreader bar connecting both thigh cuffs. L1820 covers a unilateral hip orthosis, meaning it supports only one hip joint. If the device has two thigh cuffs linked by a spreader bar, L1652 is the correct code. If it supports a single hip, L1820 applies.

The common confuser is a device marketed as a “hip abduction orthosis” that has bilateral pelvic and thigh components but uses a fixed rather than adjustable spreader bar. If the bar is not adjustable, it may not meet the L1652 descriptor precisely. Review the device’s product specification sheet alongside the PDAC verified product list entry to confirm which code the manufacturer obtained approval under. Effective denial management for DMEPOS claims almost always traces back to this code-selection step.

Common billing errors when filing L1652 claims

Most L1652 denials cluster around four root causes. Fixing these upstream, before claim submission, eliminates the majority of rework. Consistent clean claim submission for orthotic codes requires a documented pre-bill review against all four.

• Product not on PDAC verified list: The device billed is not the one approved under L1652. Always verify model number, not just brand or product line.
• Wrong code selected (L1652 vs L1820): The device is unilateral, or lacks the adjustable abductor spreader bar, but L1652 is submitted anyway. Use the comparison table above to confirm laterality and spreader bar configuration before coding.
• CMN missing or incomplete: The certificate of medical necessity was not obtained before delivery, was signed after delivery, or is missing the treating physician’s NPI. Medicare considers a post-delivery CMN invalid.
• Diagnosis code mismatch: The ICD-10-CM codes on the claim do not match the diagnoses documented in the physician’s clinical notes or on the CMN. Coders pulling codes from the claim form without reviewing the clinical documentation create this mismatch routinely.
• Billing fitting separately: Because fitting and adjustment are included in the L1652 descriptor, submitting a separate billing line for fitting services results in a duplicate-service denial.

Related HCPCS L-codes for hip and lower extremity orthotics

HCPCS code L1652 sits within a family of L-codes covering hip orthoses and lower extremity devices. Knowing the adjacent codes helps billers avoid unbundling, understand when a different code is more appropriate, and cross-reference medical billing documentation requirements across the hip orthosis category. The AAPC HCPCS Level II code lookup provides the full L-code descriptor range for cross-referencing.

How practice management software simplifies HCPCS billing

Billing HCPCS code L1652 requires coordinating at least six data points across the clinical and administrative workflow: The physician order, the CMN, the PDAC product confirmation, the ICD-10-CM diagnosis codes, the delivery confirmation, and the HCPCS code itself. In practices that use separate systems for clinical documentation and billing, one of those six handoffs becomes the failure point.

Pabau’s claims management software lets DME and orthotic practices attach L-codes directly to the patient encounter at the point of care. The biller sees the code, the associated diagnosis codes, and the documentation status in one place, without switching between the clinical record and a separate billing platform. For practices also managing physical therapy practice management, this integration means the referring therapist’s clinical notes are already in the system when the biller codes the orthotic claim.

The result is fewer transcription errors between documentation and the claim form, and a faster path from device delivery to submitted claim. Review the medical billing software options available for DME and orthotic practices to find the workflow fit for your team’s size and claim volume.

Conclusion

HCPCS code L1652 covers a clearly defined device configuration: A prefabricated bilateral hip orthosis with adjustable abductor spreader bar, adult size, fitting included. Getting the claim right requires three things before submission: Confirming the product is on the PDAC verified list, securing a completed CMN before device delivery, and selecting L1652 rather than L1820 based on the actual device laterality and spreader bar configuration.

Pabau’s claims management tools support the full DMEPOS documentation and coding workflow, from code entry through claim submission and payment reconciliation. To see how Pabau handles orthotic and DME billing for your practice, book a demo.

Continue your research

Need help managing DMEPOS claim denials? Denial management in healthcare covers the most common reasons claims are rejected and how to build a systematic appeals process.

Want to understand the broader billing framework? Revenue cycle management explained walks through how DMEPOS claims fit into the end-to-end billing lifecycle.

Building a compliant orthotic billing workflow? Medical billing compliance outlines the documentation and audit-readiness standards for Medicare DME claims.

Frequently Asked Questions