K0902 — 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 a 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. It belongs to the Durable Medical Equipment (DME MAC Temporary) section. It was terminated on December 31, 2016 and is not valid on new claims.
This code has been terminated
CMS terminated K0902 on December 31, 2016. It stays in the file as history — a claim you are auditing from before that date may legitimately carry it — but it must not appear on a new claim. The adjacent codes below are the usual place to look for its replacement.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
The CMS record for K0902
- Long descriptor
- 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
- Added
- October 1, 2014
- Terminated
- December 31, 2016
- BETOS
- D1F
- Pricing indicator
- 38 — DMEPOS
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
When CMS retired it.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Orthotics, prosthetics, prosthetic devices and vision services. Price subject to floors and ceilings.
Codes adjacent to K0902
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If K0902 is not quite right, the correct code is very often within a few positions of it.
- K0885Power wheelchair, group 4 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds
- K0886Power wheelchair, group 4 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
- K0890Power wheelchair, group 5 pediatric, single power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds
- K0891Power wheelchair, group 5 pediatric, multiple power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds
- K0898Power wheelchair, not otherwise classified
- K0899Power mobility device, not coded by dme pdac or does not meet criteria
- K0900Customized durable medical equipment, other than wheelchair
- K0901Knee 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-shelfterminated
- K0903For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, eachterminated
- K1001Electronic positional obstructive sleep apnea treatment, with sensor, includes all components and accessories, any typeterminated
- K1002Cranial electrotherapy stimulation (ces) system, any typeterminated
- K1003Whirlpool tub, walk-in, portableterminated
- K1004Low frequency ultrasonic diathermy treatment device for home use
- K1005Disposable collection and storage bag for breast milk, any size, any type, eachterminated
- K1006Suction pump, home model, portable or stationary, electric, any type, for use with external urine management systemterminated
- K1007Bilateral hip, knee, ankle, foot device, powered, includes pelvic component, single or double upright(s), knee joints any type, with or without ankle joints any type, includes all components and accessories, motors, microprocessors, sensors
Questions about K0902
What is HCPCS code K0902?
K0902 is a 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. It sits in the Durable Medical Equipment (DME MAC Temporary) section.
Does Medicare cover K0902?
The CMS HCPCS file marks K0902 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
Is K0902 still valid?
No. K0902 was terminated on December 31, 2016 and should not be used on new claims.