CommercialBilling CodesHigh impact
05.00.39x, Ankle-Foot/Knee-Ankle-Foot Orthosis
Independence Blue Cross·Orthopedics, Physical Therapy, PM&R (Physical Medicine & Rehab) +3 more·Medical Policy
Effective date
Oct 1, 2026
We identified it
Oct 2, 2026
Summary
Independence Blue Cross updated policy 05.00.39x effective 10/01/2026 to add new HCPCS code L1972 (prefabricated, off-the-shelf ankle-foot orthosis) to the medically necessary/covered section and revised the definition of existing code L1971 (customized prefabricated ankle-foot orthosis). Billing teams must implement these code changes in their systems and ensure claims are submitted using the correct code based on whether the orthosis is off-the-shelf or customized.
Action Required
By 10/01/2026: Billing team must update billing system software to recognize new HCPCS code L1972 as medically necessary/covered for Independence Blue Cross Commercial plans. Update system logic to distinguish between L1971 (customized/trimmed/molded prefabricated AFO) and L1972 (off-the-shelf AFO). Verify that both codes are reflected in the system's coverage tables and that claims submitted with L1971 or L1972 will not be incorrectly denied or flagged. Review current claims queue for any L1971 or L1972 submissions and confirm they are coded correctly. Notify providers and orthotic suppliers that L1972 is now a separately billable covered code distinct from L1971, and provide education on code selection based on product type. Update internal documentation and billing manuals to reflect the revised policy language for both codes.