K0902 HCPCS code: Knee orthosis (ko), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf

K0902 is the HCPCS Level II code for knee orthosis (ko), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf. CMS terminated K0902 on 2016-12-31; do not bill it for later dates of service. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case.

Code details

FieldValue
SectionK codes — Temporary codes for DME MACs
Coverage codeC — Carrier judgment
Pricing indicator38 — DMEPOS: orthotics, prosthetics, prosthetic devices and vision services
BETOS categoryD1F — Prosthetic and orthotic devices
Added2014-10-01
Last action effective2017-01-01
Terminated2016-12-31

What changed for K0902

Frequently asked questions

What is HCPCS code K0902?

K0902 is the HCPCS Level II code for knee orthosis (ko), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf. Short descriptor: "Ko double upright pre ots".

Does Medicare cover K0902?

Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.

Related K09 codes

Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.

Next steps

Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.

All K codes · HCPCS lookup