Orthosis - Ankle Foot (AFO) - Custom Made

When to use this code

Use this code for assistive technology items that help the participant perform daily tasks or improve their independence. AT can include mobility aids, communication devices, personal care equipment, and home automation tools. Most AT purchases over $1,500 require an assessment report from a qualified therapist.

Common billing scenarios

• A participant needs a powered wheelchair. The AT supplier provides a quote for $8,500 after an occupational therapist completes the assessment. Once approved, the provider claims against this code.
• An AT item needs repair costing $600. The provider submits a quote for the repair, and once approved, claims the cost under the relevant AT code.

Provider notes

• This is a quotable support, so there is no fixed price limit. You will need to submit a detailed quote to the NDIA or the participant’s plan manager before delivering the service. The quote should break down the expected costs and justify why the amount is reasonable.
• Capital supports are one-off or infrequent purchases rather than ongoing services. Make sure you have the required assessments and approvals before purchasing or delivering items. Capital funding cannot be moved to other budget categories.