Medicare AdvantageBilling CodesHigh impact
MA05.010m, 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 MA05.010m updated HCPCS codes for ankle-foot orthoses effective 10/01/2026: code L1971 (customized prefabricated AFO) was revised, new code L1972 (off-the-shelf AFO) was added to medically necessary section, and ICD-10 codes for plantar fasciitis and plantar fascial fibromatosis were expanded with laterality specificity (M67.A01, M67.A02, M67.A09, M72.20, M72.21, M72.22), replacing the non-specific M72.2 code.
Action Required
By September 15, 2026: Billing team must update billing system to recognize and process new HCPCS code L1972 (off-the-shelf AFO) as medically necessary under MA05.010m. Immediately replace ICD-10 code M72.2 with laterality-specific codes M72.20 (unspecified foot), M72.21 (right foot), or M72.22 (left foot) in all billing templates and system logic. Add ICD-10 codes M67.A01, M67.A02, and M67.A09 (plantar fasciitis with laterality) to the medically necessary diagnosis list for procedure codes L4392, L4396, L4397. Update claims scrubbing rules to flag claims using old code M72.2 for correction before transmission to Independence Blue Cross Medicare Advantage. Train providers and front desk staff on required diagnosis code specificity (laterality) for all orthosis claims. Failure to update codes and use laterality-specific diagnoses will result in claim denials for Independence Blue Cross Medicare Advantage members.