K0901 Knee orthosis (ko), single 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 single upright pre ots

⚠ Terminated HCPCS Level II 2026
Terminated Code
K0901 was terminated as of 2016-12-31 and should not be reported for dates of service after that date. This page is retained for historical reference.
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K0901 is the HCPCS Level II code for Knee orthosis (ko), single 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 (2026). It belongs to Section K — Durable Medical Equipment (Temporary). Under Medicare, its coverage status is: Carrier judgment. Part B pricing methodology: Orthotics, prosthetics & vision services.

Classification & CMS Attributes

Medicare Coverage
Carrier judgment (code C)
Part B Pricing
Orthotics, prosthetics & vision services (indicator 38)
Type of Service
Lump-sum purchase of DME, prosthetics, orthotics
Effective Date
2017-01-01
Termination Date
2016-12-31
2026 Maintenance
No change this year

References

Cite This Page

Reference K0901 with the canonical source and edition:

K0901 — Knee orthosis (ko), single 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. ICD-10 Coding Pro (HCPCS Level II 2026). https://icd10codingpro.com/hcpcs-codes/K0901

Canonical URL: https://icd10codingpro.com/hcpcs-codes/K0901

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Reviewed by Prajwal Shrestha, CPC, CRC
Certified Professional Coder (CPC) and Certified Risk Adjustment Coder (CRC) · AAPC Member ID 01997614 · About · Editorial policy · Content last reviewed: 2026-01-01

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