Tillges Technologies, LLC Lower Extremity Solutions Extremity Product... · Tillges Technologies,...

Tillges Technologies, LLC

Lower Extremity SolutionsOur highly skilled and qualified technicians collaborate with our certified practitioners in fabricating these custom-made products.

Tillges Technologies is your go-to central fabrication facility for Minnesota Custom AFO bracing and other orthotic device needs. We employ highly skilled and qualified orthotic and prosthetic technicians who assist our certified practitioners in fabricating our custom-made devices. We pride ourselves on LEAN initiatives to reduce lead times and to continuously improve our quality standards on the products and services we provide. Tillges Technologies was founded in 2012 by Robert, Michael and Steve Tillges, whom are all certified prosthetists and orthotists at Tillges Certified Orthotic Prosthetic in Maplewood, Minnesota.

Table of ContentsMasterflex AFO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 - 4

Thermoplastic AFO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 - 10

Partial Foot Solution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Minnesota Boot AFO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 - 13

ICD-10 Reference Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

AOPA Approved Coding Letter . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Lower Limb Orthoses Physician Letter . . . . . . . . . . . . . . . . . . . . 16

Medicare Coverage Criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

PressureGuardian® Overview . . . . . . . . . . . . . . . . . . . . . . . 18 - 19

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©2016 Tillges Technologies, LLC. All rights reserved. PressureGuardian® is a registered trademark of Tillges Technologies, LLC.The final and sole responsibility for the correct coding, with established laws, rules and standards of practice, rests upon the party submitting the claim.

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31-855-4TILTEC (484-5832) | Fax 651-748-4574 | www.tillgestechnologies.com

Supra-Malleolar Masterflex AFOA custom fabricated AFO that stabilizes the ankle providing medial-lateral ankle support with limited plantar-flexion and dorsi-flexion. Provides stabilization to the ankle, subtalar and mid-tarsal joints. The SMO Masterflex AFO is lower profile than the standard Masterflex AFO, which extends just proximal to the malleoli.

FEAturES• Soft, flexible molded inner boot design

• Rigid co-poly outer frame design

• Metatarsal length footplate

• Anatomical reliefs

• 1” Velcro strap closure

• Color: white or black

cLInIcAL IndIcAtIonS• Ankle instabilities

• Achilles tendonitis

• Trauma to the ankle or foot

• Severe pes planus or pronation

• Posterior or anterior tibial tendonitis

• PTTD (Posterior Tibial Tendon Dysfunction)

• Talocalcaneal varus or valgus foot deformity

• Mild DJD (Degenerative Joint Disease) or ankle arthritis

SuggEStEd L codESL1907, L2280, L2275

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FEAturES• Soft, flexible molded inner boot design

• Rigid co-poly outer frame design

• Metatarsal, sulcus or full- length footplate

• Anatomical reliefs

• 1” Velcro strap closure

• Extends higher above ankle for increased support


cLInIcAL IndIcAtIonS• Ankle instabilities

• Achilles tendonitis


• Severe pes planus or pronation




• DJD (Degenerative Joint Disease) or ankle arthritis

SuggEStEd L codESL1940, L2280, L2275

Masterflex AFOA custom fabricated AFO that stabilizes the ankle providing medial-lateral ankle support with limited plantar-flexion and dorsi-flexion. Provides stabilization to the ankle, subtalar and mid-tarsal joints. The Masterflex AFO is taller than the Supra-Malleolar Masterflex AFO, which extends an additional 3” proximally.


thErMopLAStIc AFo

Leaf Spring AFOA custom fabricated, semi-rigid, thermoplastic AFO that stabilizes the ankle providing medial-lateral ankle support with limited plantar-flexion and dorsi-flexion. Provides stabilization to the ankle, subtalar and mid-tarsal joints. This design limits plantar-flexion, allowing toe clearance through swing phase of gait to provide a more natural gait.

FEAturES• Semi-rigid thermoplastic design

• 3 profile designs: PLS (#1), semi-solid (#2), solid (#3)


• Varus or valgus correction

• Choice of ankle strap: 1” Velcro riveted, 1” Velcro Figure 8, 1” Velcro dynamic, or no ankle strap

• 1-1/2” Velcro calf strap with tibial pad


cLInIcAL IndIcAtIonS• Drop foot

• Neuropathy

• Ankle instabilities

• Multiple sclerosis

• CVA (Cerebral Vascular Accident)






SuggEStEd L codES*L1940 *Add L2270 for dynamic ankle strap *Add L2275 for varus/valgus correction

PLS #1 Semi-Solid #2 Solid #3

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FEAturES• Rigid thermoplastic design



• Choice of ankle strap: 1” Velcro riveted, 1” Velcro Figure 8, 1” Velcro dynamic, or no ankle strap

• Two 1-1/2” Velcro calf straps with pre-tibial interlocking shell



• Neuropathy

• Charcot foot

• Stroke patient



• Mild genu recuvatum







SuggEStEd L codES*L1960, L2340 *Add L2270 for dynamic strap *Add L2275 for varus/valgus correction

Solid Ankle AFOA custom fabricated, rigid, thermoplastic AFO that stabilizes the ankle providing medial-lateral ankle support while eliminating plantar-flexion and dorsi-flexion. Holds ankle in subtalar neutral position. Provides stabilization to the ankle, subtalar and mid-tarsal joints. This design eliminates plantar-flexion, allowing toe clearance through swing phase of gait to provide a more natural gait.


thErMopLAStIc AFo

Convertible AFOA custom fabricated, rigid, thermoplastic AFO that stabilizes the ankle providing medial-lateral ankle support while eliminating plantar-flexion and dorsi-flexion. Holds ankle in subtalar neutral position. Provides stabilization to the ankle, subtalar and mid-tarsal joints. This design eliminates plantar-flexion allowing toe clearance through swing phase of gait providing a more natural gait. This unique brace allows for future articulation at the ankle level when the patient reaches that point in their rehabilitation process.

FEAturES• Rigid thermoplastic design• Metatarsal, sulcus or full-length footplate• Varus or valgus correction• Adjustable or 90 degree posterior stop options• Choice of ankle strap: 1” Velcro riveted, 1” Velcro Figure 8, 1” Velcro dynamic, or no ankle strap• Two 1-1/2” Velcro calf straps with pre-tibial interlocking shell• Color: white or black

cLInIcAL IndIcAtIonS• Drop foot• Neuropathy• Charcot foot• Stroke patient• Ankle instabilities• Multiple sclerosis• Mild genu recuvatum• Trauma to the ankle or foot• CVA (Cerebral Vascular Accident)• Posterior or anterior tibial tendonitis• PTTD (Posterior Tibial Tendon Dysfunction)• Talocalcaneal varus or valgus foot deformity• DJD (Degenerative Joint Disease) or ankle arthritis

SuggEStEd L codES*L1970, L2220 (x2), L2340 *Add L2270 for dynamic strap*Add L2275 for varus/valgus correction

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• Tamarack (regular or dorsi assist) or Oklahoma joint option

• Choice of ankle strap: 1” Velcro riveted or 1” Velcro dynamic strap, or no ankle strap

• One 1-1/2” Velcro calf strap



• Neuropathy

• Charcot foot

• Stroke patient



• Mild genu recuvatum







SuggEStEd L codES*L1970

Low Profile Articulated AFOA custom fabricated, hinged, low profile thermoplastic AFO design with free motion that stabilizes the ankle providing medial-lateral ankle support and reduces forefoot abduction or adduction. Holds the ankle in subtalar neutral position. Provides stabilization to the ankle, subtalar and mid-tarsal joints. This AFO manages abnormal motion or severe pronation in the transverse and frontal planes. Constructed with either dorsi- or plantar-flexion assist or resist joints.

*Add L2220 (x2) for plantar-flexion assist/resist joints *Add L2210 (x2) for dorsi-flexion assist joints *Add L2270 for dynamic strap *Add L2275 for varus/valgus correction


FEAturES• Rigid thermoplastic design• Metatarsal, sulcus or full- length footplate• Varus or valgus correction• Tamarack (regular or dorsi assist) or Oklahoma joint option• Adjustable or 90 degree posterior stop options or free motion design• Choice of ankle strap: 1” Velcro riveted or 1” Velcro dynamic strap, or no ankle strap• Two 1-1/2” Velcro calf straps with pre-tibial interlocking shell• Color: white or black

cLInIcAL IndIcAtIonS• Drop foot• Neuropathy• Charcot foot• Stroke patient• Ankle instabilities• Multiple sclerosis• Mild genu recuvatum• Trauma to the ankle or foot• CVA (Cerebral Vascular Accident)• Posterior or anterior tibial tendonitis• PTTD (Posterior Tibial Tendon Dysfunction)• Talocalcaneal varus or valgus foot deformity• DJD (Degenerative Joint Disease) or ankle arthritis

SuggEStEd L codES*L1970

Articulated AFOA custom fabricated, hinged, thermoplastic AFO design that stabilizes the ankle providing medial-lateral ankle support and reduces forefoot abduction or adduction. Holds the ankle in subtalar neutral position. Provides stabilization to the ankle, subtalar and mid-tarsal joints. This AFO manages abnormal motion or severe pronation in the transverse and frontal planes. Constructed with either dorsi- or plantar-flexion assist or resist joints. Available with posterior stop options or free motion design.

*Add L2220 (x2) for plantar-flexion assist/resist joints *Add L2210 (x2) for dorsi-flexion assist joints *Add L2270 for dynamic strap *Add L2275 for varus/valgus correction

thErMopLAStIc AFo

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Unloader AFOA custom fabricated thermoplastic AFO that stabilizes the ankle providing medial-lateral ankle support while eliminating plantar-flexion and dorsi-flexion. Holds ankle in a rigid position at all times. Provides stabilization to the ankle, subtalar and mid-tarsal joints. Lacer/Velcro upper construction to allow for maximum conforming around the calf belly which unloads the weight at the foot and ankle. This design eliminates plantar-flexion allowing toe clearance through swing phase of gait to provide a more natural gait.


• Solid ankle or jointed angle design



• Ankle reinforcement option

• Choice of ankle strap: 1” Velcro riveted or 1” Velcro dynamic strap

• Three to Five 1-1/2” Velcro calf straps with pre-tibial interlocking shell


cLInIcAL IndIcAtIonS• Foot drop

• Neuropathy

• Charcot foot

• Ankle Arthritis


• Achilles tendon rupture


• Ankle or lower leg fractures





SuggEStEd L codES*L1960, L2330, L2340 *Add L2270 for dynamic strap *Add L2275 for varus/valgus correction

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FEAturES• Rigid carbon thermoplastic design

• Full-length rigid footplate


• Reinforced ankle and posterior strut

• Choice of ankle strap: 1” Velcro riveted, 1” Velcro Figure 8, or 1” Velcro dynamic


cLInIcAL IndIcAtIonS• Trans-metatarsal amputation

• Chopart amputation

• Lisfranc amputation

• Other partial foot amputation

SuggEStEd L codESL5020, L5785

Partial Foot ProsthesisA custom fabricated, rigid, carbon thermoplastic prosthesis that stabilizes the ankle providing medial-lateral ankle support. Holds ankle in a rigid position at all times. This design allows for a longer toe lever for a patient having a partial foot amputation, returning their third rocker in gait. The longer toe lever also offers improved balance throughout gait.

pArtIAL Foot SoLutIon

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MN Boot Solid AFOA custom fabricated, rigid, thermoplastic AFO that stabilizes the ankle providing medial-lateral ankle support while eliminating plantar-flexion and dorsi-flexion. Holds ankle in subtalar neutral position. Provides stabilization to the ankle, subtalar and mid-tarsal joints. The plantar surface is constructed with a removable inner molded boot to allow for excavation under ulcer sites for pressure reduction. This design eliminates plantar-flexion allowing toe clearance through swing phase of gait to provide a more natural gait while incorporating a rocker sole design for a smooth roll over from heel to toe.


• Rocker bottom sole

• Full-length footplate

• Ventilated calf design

• Ankle reinforcement

• Multi durometer inner molded removable boot

• Ability to excavate under ulcers to reduce pressures


• 1-1/2” Dacron backed ankle strap

• 1-1/2” Dacron backed forefoot strap


cLInIcAL IndIcAtIonS• Wound management

• Diabetes

• Neuropathy

• Charcot foot


• Toe amputations

• Partial foot amputation

• Post-op management

• Foot and ankle ulcerations




SuggEStEd L codESL1960, L2280, L2340, L2232, L2275

Dorsal Cover

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Dorsal Cover

FEAturES• Rigid thermoplastic design• Rocker bottom sole• Full-length footplate• Ventilated calf design• Ankle reinforcement• Multi durometer inner molded removable boot• Ability to excavate under ulcers to reduce pressures• Lacer/Velcro upper design for maximum unloading of the foot and ankle• Varus or valgus correction• 1-1/2” Dacron backed ankle strap• 1-1/2” Dacron backed forefoot strap• Four to Five 1-1/2” Velcro calf straps with pre-tibial interlocking shell

cLInIcAL IndIcAtIonS• Wound management• Diabetes• Neuropathy• Charcot foot• Ankle instabilities• Toe amputations• Partial foot amputation• Post-op management• Foot and ankle ulcerations• Trauma to the ankle or foot• Talocalcaneal varus or valgus foot deformity• DJD (Degenerative Joint Disease) or ankle arthritis

SuggEStEd L codESL1960, L2280, L2330, L2232, L2275

MN Boot Unloader AFOA custom fabricated, rigid, thermoplastic AFO that stabilizes the ankle providing medial-lateral ankle support while eliminating plantar-flexion and dorsi-flexion. Holds ankle in subtalar neutral position. Provides stabilization to the ankle, subtalar and mid-tarsal joints. Lacer upper construction to allow for maximum conforming around the calf belly which unloads the weight at the foot and ankle. The plantar surface is constructed with a removable inner molded boot to allow for excavation under ulcer sites to reduce pressure. This design eliminates plantar-flexion allowing toe clearance through swing phase of gait to provide a more natural gait while incorporating a rocker sole design for a smooth roll over from heel to toe.

MInnESotA boot AFo

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#1 Lateral side of forefoot 3rd-5th metatarsal phalangesAnkle varus deformity (L)M21 .172 (R)M21 .171Congenital pes cavus (L)Q66 .7 (R)Q66 .7Ankle instability (L)M25 .372 (R)M25 .371Foot drop (L)M21 .372 (R)M21 .371

#2 Medial side of forefoot 1st-3rd metatarsal phalangesAnkle valgus deformity (L)M21 .072 (R)M21 .071Posterior tibial tendonitis (L)M76 .822 (R)M76 .821Ankle instability (L)M25 .372 (R)M25 .371Foot drop (L)M21 .372 (R)M21 .371

#3 Lateral side of midfootAnkle varus deformity (L)M21 .172 (R)M21 .171Congenital pes cavus (L)Q66 .7 (R)Q66 .7Ankle instability (L)M25 .372 (R)M25 .371Non-Diabetic Charcot deformity (L)M14 .672 (R)M14 .671Diabetic Charcot deformity (L)E10 .610 (R)E10 .610

#4 Medial side of midfootAnkle valgus deformity (L)M21 .072 (R)M21 .071Posterior tibial tendonitis (L)M76 .822 (R)M76 .821Ankle instability (L)M25 .372 (R)M25 .371Non-Diabetic Charcot deformity (L)M14 .672 (R)M14 .671Diabetic Charcot deformity (L)E10 .610 (R)E10 .610

#5 Lateral side of heelAnkle varus deformity (L)M21 .172 (R)M21 .171Congenital pes cavus (L)Q66 .7 (R)Q66 .7Ankle instability (L)M25 .372 (R)M25 .371

#6 Medial side of heelAnkle valgus deformity (L)M21 .072 (R)M21 .071Ankle instability (L)M25 .372 (R)M25 .371

#7 Medial side of ankleAnkle valgus deformity (L)M21 .072 (R)M21 .071Ankle instability (L)M25 .372 (R)M25 .371

#8 Lateral side of ankleAnkle varus deformity (L)M21 .172 (R)M21 .171Congenital pes cavus (L)Q66 .7 (R)Q66 .7Ankle instability (L)M25 .372 (R)M25 .371

*This ICD-10 Reference Chart is a recommended guideline only. It is the responsibility of the dispensing clinician to determine the appropriate medical diagnosis based on Medicare and Medicaid regulations.

#1 #2

#3 #4

#5 #6

#7 #8

©2016 Tillges Technologies, LLC.

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Foot Deformity ICD-10 Reference Chart Relating to Wound Sites*


AOPA Approved Coding Letter AopA ApprovEd codIng LEttEr

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Medicare

December 2010

Lower Limb Orthoses – Coverage Criteria and Physician Documentation Requirements Dear Physician, Leg braces are covered by Medicare when they are required to support the limb and/or restrict or eliminate motion of a joint because of disease, injury, congenital condition, or orthopedic surgical procedure. Although elastic supports may be beneficial to treat certain conditions, they are not eligible for coverage under the Medicare statutory brace benefit. Also, brace-like items that are used solely for pressure reduction and/or wound healing—e.g., devices used for the treatment of foot ulcers—are not eligible for coverage under the brace benefit. The medical necessity for the brace must be clearly documented in the patient’s medical records. The records could include your office notes, hospital records (e.g., operative note or discharge summary), or the records of other healthcare professionals (e.g., physical therapists or occupational therapists). The records must indicate the diagnosis and pertinent history (including symptoms, progression of the disease, other treatments that have been utilized—as applicable), type of injury, or surgical procedure. It should describe whether the patient will be ambulatory with the brace. There must be a physical examination of the affected body part, including (as applicable): presence of deformity, swelling, tenderness, contracture, or spasticity; objective assessment of joint laxity/stability; range of motion; etc. Simply listing this information on the order or on a form provided by the supplier is not sufficient. It must be documented in the patient’s medical records. A prefabricated brace without or with custom fitting is appropriate for most patients. The need for a completely custom fabricated brace must be justified in either the patient’s medical records or in the supplier’s records. There must be a detailed written order that lists the specific type of brace that is being ordered, including all separately billable features. If a custom fabricated brace is being ordered, this must be clearly indicated. This document may be prepared by the supplier, but you must review it, initial and date any changes, and then personally sign and date the order. Signature and date stamps are not acceptable. Verbal orders alone are not sufficient for Medicare coverage.

Lower Limb Orthoses Physician LetterLo

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We have received referrals from your office to provide an Ankle Foot Orthosis (posterior solid ankle, plastic, custom fabricated) for your patient(s) . Please be advised that Medicare’s documentation requirements have recently changed and payment for an orthosis is now based solely on the information in the physician’s records . Therefore the following information must be included in your medical records in order to be in compliance with Medicare . “If an Ankle Foot Orthosis is provided and the coverage criteria are not met it will be denied as not medically necessary” per Medicare guidelines, and your patient may be held responsible for cost .

• Recent Physical Exam specific to the foot or ankle deformity . Include presence of deformity, swelling, tenderness, contracture, or spasticity: objective assessment of joint laxity/stability, range of motion, weight, height, weight loss/gain etc .

• Document that Criteria for Coverage is met 1) patient is ambulatory 2) weakness/deformity of the foot and ankle, 3) the medical need for foot and ankle stabilization, 4) that the patient has the potential to benefit functionally from the Ankle Foot Orthosis .

• One of the following conditions must also be documented 1) permanent condition >6 months, or 2) prefabricated device did not fit, or 3) need to control the ankle, or foot in more than one plane, or 4) neurological, circulatory, or orthopedic status requires custom fabricated over a model to prevent tissue injury, or 5) healing fracture that lacks normal anatomical integrity or anthropometric proportions .

• Recommendation for the new Orthosis/component(s) Include the type of device and that custom device is required and you’re rational for ordering it . Each note must have your signature and date; and each page needs the patients name recorded .

Minnesota Boot L-1960 AFO and Crow WalkerAnkle-foot orthoses (AFO) described by codes L1900, L1902-L1990, L2106-L2116, L4350, L4360, L4386, L4387 and L4631 are covered for ambulatory beneficiaries with weakness or deformity of the foot and ankle, who:

1 . Require stabilization for medical reasons, and,

2 . Have the potential to benefit functionally .

For custom fabricated orthoses (L1904, L1907, L1920, L1940-L1950, L1960, L1970, L1980-L2034, L2036-L2038, L2106-L2108, L2126-L2128, L4631), there must be detailed documentation in the treating physician’s records to support the medical necessity of custom fabricated rather than a prefabricated orthosis as described in the Coverage Indications, Limitations and/or Medical Necessity section above . This information will be corroborated by the functional evaluation in the orthotist or prosthetist’s records . This information must be available upon request .

Code L4631 describes a Charcot’s restraint orthotic walker (CROW) orthosis . Code L4631 is a custom fabricated ankle-foot orthosis which has all of the following characteristics:

1 . Designed to maintain the foot at a fixed position of 0° (i .e ., perpendicular to the lower leg) .

2 . Allows for varus or valgus deformity correction .

3 . Contains a rocker bottom sole with a custom arch support .

4 . Incorporates a rigid anterior tibial shell .

5 . Used by a beneficiary who is ambulatory .

6 . Has a soft interface .

Code L4631 includes all additions including straps and closures . No additional codes may be billed with code L4631 .

Ankle Foot Orthosis (Posterior Solid Ankle, Plastic, Custom Fabricated)

MEdIcArE covErAgE crItErIA

www.pressureguardian.com

PressureGuardian® is a pressure sensor tool advancing the outcome of prosthetic and orthotic devices while providing measurement, accuracy and success for your facility and your patients.

PressureGuardian is able to help clinicians manage their patients’ diabetic wounds with astonishing results, as well as assist practitioners in fine-tuning the fit of custom orthotic and prosthetic devices.

Measurement, Accuracy, Success.

www.pressureguardian.com | [email protected]

www.pressureguardian.com | [email protected]

• Collects and manages patient data with ease.

• Provides documentation for insurance claims.

• Provides evidence-based practice with outcome measures.

• Helps clinicians manage their patients’ diabetic wounds with astonishing results.

• Provides a non-invasive evaluation that can be repeated at short intervals.

• Provides tangible, visible biofeedback for increased patient compliance.

• Educates patients and clinicians on static and dynamic pressure loads.

• Aids practitioners in fine-tuning the fit of custom orthotic and prosthetic devices.

• Provides static and dynamic pressure and force measurements during normal gait cycle.

• Captures multiple sequential foot strikes to analyze pressure loads, saving you time.

PressureGuardian Benefits

Home Screen Real-Time Pressure Readings Four Report Options Patient Report

PressureGuardian combines sophisticated, instantaneous pressure load measurement with a compatible app that collects, stores and transmits data to Apple iOS devices such as iPhone, iPad and iPod Touch.

To order your PressureGuardian system or for further pricing and product details, please call us at 1-855-4TILTEC (484-5832).

©2016 Tillges Technologies, LLC. All rights reserved.

Tillges Technologies, LLC1570 Beam Avenue, Suite 100, Maplewood, MN 55109

1-855-4TILTEC (1-855-484-5832)Fax 651-748-4574

[email protected] | www.tillgestechnologies.com

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