HCPCS code L1700 – Toronto-type Legg Perthes orthosis

Key takeaways

HCPCS Code L1700 is a Legg perthes orthosis, Toronto type, custom fabricated. It is a pediatric hip containment device, although some online listings describe it as a knee orthosis.

The Toronto design holds both hips in abduction and slight internal rotation, while still letting the child stand, walk and sit.

Most patients are children, so Medicaid and commercial plans pay far more L1700 claims than Medicare does.

L1700 is on the CMS Master List but on neither Required List, so Medicare asks for no prior authorization or face-to-face encounter.

Support the claim with M91.11 or M91.12 for Legg-Calvé-Perthes disease, coded to the side the record documents.

HCPCS Code L1700: Official description and key details

HCPCS Code L1700 is the permanent national Level II code for a Legg perthes orthosis, Toronto type, custom fabricated. CMS lists it with that exact wording on its DMEPOS Master List. The code describes a hip orthosis for children with Legg-Calvé-Perthes disease, built from scratch for one patient.

The descriptor names only the Toronto design and the custom fabrication. It does not mention fitting, adjustment or replacement parts, so none of those can be assumed to sit inside the code.

What the Toronto design is

The Toronto orthosis was described by W. P. Bobechko and colleagues in a 1968 paper in Artificial Limbs. It replaced plaster abduction casts, which kept children immobile for months and stiffened their knees and ankles.

The brace holds the legs at 90 degrees of abduction to each other, with the feet turned slightly inward. Two thigh cuffs sit on a rigid frame. Tie rods with ball joints connect that frame to foot blocks, and the child’s shoes are fixed to those blocks.

Because of the ball joints, the child can still stand, walk and sit in the device. That weight-bearing movement, with the femoral head held deep in the acetabulum, is what the design was built to allow.

What custom fabricated means for L1700

Custom fabricated means the orthosis is made for one named patient, from that patient’s measurements, tracings or a model. A prefabricated device is made in advance and then fitted, and it belongs on a different code.

Every code from L1700 to L1755 is custom fabricated. So fabrication level never decides which code in this family you bill. The design does.

Custom fabrication still has to be justified in the record. Ask the ordering orthopedic surgeon to note why a prefabricated hip abduction orthosis would not hold this child’s hips in the position the treatment needs.

Who pays for L1700 claims

Legg-Calvé-Perthes disease is a childhood condition, so the payer on an L1700 claim is rarely Medicare. Medicare covers children only in narrow cases, such as end-stage renal disease. Most L1700 claims go to a state Medicaid program, a Children’s Health Insurance Program (CHIP) plan or a commercial insurer.

That changes where you look for the rules. A Medicare-only checklist will miss the prior authorization, age limits and replacement rules that a Medicaid plan sets for pediatric orthoses.

• Medicaid and CHIP: Children under 21 on Medicaid are covered by the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Check your state’s orthotic fee schedule and its prior authorization rules before fabrication starts.
• Managed Medicaid and commercial plans: Many publish their own orthotic policy. Centene’s DME and orthotics policy CP.MP.107 covers L1700 when an orthopedic surgeon orders it for a child with Legg-Calvé-Perthes disease.
• Medicare: Where Medicare does pay, the DME MAC for the beneficiary’s state processes the claim. Coverage code C leaves the coverage decision to that contractor’s judgment.

Verify the payer and its policy before the fitting appointment. A custom device made for one child cannot be resold or reissued if the claim fails.

Medicare reimbursement and the DMEPOS fee schedule

Medicare pays L1700 from the CMS DMEPOS fee schedule, which is updated every January. Pricing indicator 38 means the state fee amounts are held between a national floor and ceiling. Your DME MAC pays the lower of the billed charge and the fee schedule amount.

Medicaid and commercial payers set their own rates for L1700, and many publish them in a separate orthotic fee schedule. Third-party aggregators often lag behind those files, so price from the payer’s own document.

Documentation requirements for L1700 claims

L1700 sits on the CMS Master List of DMEPOS items potentially subject to conditions of payment. It is not on the Required Prior Authorization List or the Required Face-to-Face Encounter and Written Order Prior to Delivery List. So Medicare’s standard order and delivery rules apply, with no extra pre-delivery steps.

Those standard rules still need a complete file. Build it from these records:

• Standard written order: The order names the beneficiary, the order date, the item and the quantity. It also carries the practitioner’s name or NPI and their signature. CMS sets these elements out in MLN article SE20007. It must be on file before you submit the claim.
• Clinical notes: The orthopedic surgeon’s diagnosis of Legg-Calvé-Perthes disease, the affected side, and the imaging findings behind it.
• Treatment rationale: Why containment in abduction and internal rotation is the chosen treatment, and why the Toronto design was prescribed.
• Custom fabrication rationale: Why a prefabricated hip abduction orthosis would not meet this child’s need.
• Fabrication and fitting records: The measurements or model used, the fitting date, and each later adjustment with its own date.
• Proof of delivery: A delivery receipt signed by the parent or guardian, with the date the child received the orthosis.

Medicaid and commercial plans often add their own conditions, such as prior authorization or a prescription from a named specialty. Add those to the file before fabrication starts, while a missing item can still be fixed.

Modifier requirements when billing L1700

Each payer sets its own modifier rules for L1700. Check your DME MAC policy articles and each plan’s billing manual before you add one.

The Toronto orthosis is one device that spans both legs, so it bills as one unit of L1700. Ask the payer how it wants a single bilateral device reported before you add RT or LT. Some plans want no laterality modifier at all on this code.

Orthoses are purchased items, so rental modifiers such as RR do not belong on an L1700 claim.

Billing guidelines and claim submission for L1700

A clean L1700 claim follows the order of the records. Most denials on custom orthoses trace back to a step done out of sequence. The sequence below splits at the start of fabrication, the point after which a missing item can no longer be fixed.

1. Confirm the payer and its policy: Identify the child’s plan, check eligibility and request prior authorization where the plan requires it.
2. Obtain the written order: Get the signed order from the orthopedic surgeon, naming the Toronto-type orthosis.
3. Check the clinical support: Make sure the notes give the diagnosis, the side, the imaging and the custom fabrication rationale.
4. Fabricate, fit and deliver: Record the measurements, the fitting date and every adjustment, then collect a signed delivery receipt.
5. Code the claim: Bill one unit of L1700 with the ICD-10-CM code that matches the documented side, plus any modifier the payer requires.
6. Submit and keep the file: Send the claim electronically and keep the full record for at least seven years.

Every field has to match across the file before the claim leaves your system. That means the diagnosis code, the side, the order date, the delivery date and the patient details.

Related HCPCS codes in the Legg Perthes L1700-L1755 range

HCPCS Code L1700 opens a five-code family of Legg Perthes orthoses. All five are custom fabricated hip containment devices, so the prescribed design alone decides which one applies.

L1710 and L1720 are not upgraded versions of L1700. Each one is a separate hip orthosis design with its own base code.

Billing L1700 for a Newington or Scottish Rite device is a coding error, whatever the diagnosis. A Scottish Rite brace bills as L1730, and a patten bottom brace as L1755.

L1700 is also unrelated to the knee orthosis codes. An elastic knee brace with condylar pads and joints is billed with L1820 or L1821, depending on how it was fitted. Some online listings mix the two up, so check the CMS descriptor before you code.

Confirm current code status in the CMS HCPCS overview and its quarterly update files.

ICD-10 diagnosis codes that support L1700 claims

The diagnosis on an L1700 claim is almost always Legg-Calvé-Perthes disease. ICD-10-CM classifies it as juvenile osteochondrosis of the head of the femur, category M91.1, coded to the affected leg.

M91.1 has no bilateral code. When both hips are involved, report M91.11 and M91.12 together.

An unspecified code such as M91.10 invites a records request on a custom device, because the payer cannot see which hip the orthosis treats. Ask the surgeon to state the side in the note. Our ICD-10-CM code reference holds the guides for the diagnosis codes behind these claims.

Common L1700 billing errors and how to avoid them

Denials on this code cluster around a few repeatable mistakes. Each one can be caught at intake or fitting.

• Treating L1700 as a knee orthosis: Some references describe L1700 with knee brace wording. Work from the CMS descriptor, which names a Toronto-type Legg Perthes orthosis.
• Billing the design the practice supplies most often: Match the code to the device the surgeon prescribed and you delivered. Toronto, Newington, trilateral, Scottish Rite and patten bottom each have their own code.
• Leaving custom fabrication unexplained: A diagnosis alone does not show why a prefabricated orthosis was ruled out.
• Using Medicare rules for a Medicaid patient: Confirm which plan covers the child, then read its prior authorization rules before fabrication.
• Mismatching the side: The order, the note and the ICD-10-CM code must all name the same hip.

How Pabau keeps an L1700 claim file audit-ready

Most orthotic suppliers build a custom orthosis file by hand. The order arrives by fax, the imaging report sits in the hospital chart, and the fitting notes are on paper. Nobody sees the whole file until a payer asks for it.

Pabau, our practice management platform, keeps those records on one patient timeline. The written order, the prior authorization, the fitting history and the signed delivery receipt all sit together, each with its date. Our claims management software then carries the code, the diagnosis and any modifier onto the claim.

Your billing team can check the side, the order date and the delivery date in seconds, before the claim leaves. Fewer L1700 claims come back for records, and more of them pay on the first pass.

Keep every custom orthosis claim file complete

Pabau keeps written orders, fitting notes and delivery receipts on one patient record, then carries the code and diagnosis onto the claim.

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Conclusion

HCPCS Code L1700 pays for one specific device: a custom fabricated Toronto-type orthosis for a child with Legg-Calvé-Perthes disease. The descriptor says little, so the claim stands on the file behind it.

Bill the design that was prescribed and code the side the surgeon documented. Then price the claim from the child’s own payer, not the Medicare schedule. Book a demo to see how Pabau keeps the order, the fitting and the claim on one record.

Continue your research

Need guidance on orthotic denial patterns? Denial management in healthcare covers ways to find and fix the most common claim rejection reasons.

Wondering what makes a claim pay on the first pass? What is a clean claim sets out the data elements a payer checks before it accepts a submission.

Looking at the wider compliance picture? Medical billing compliance outlines the rules DMEPOS suppliers follow to stay audit-ready.

Want to tighten the whole billing workflow? Revenue cycle management explains the path from order intake through payment posting.

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