Section 51161 - Orthotic and Prosthetic Appliances and ServicesThe following definitions shall apply only to Sections 51315, 51315.1 and 51315.2:
(a) "Abduction and Rotation Bar" means a rigid bar that is attached to the feet to maintain appropriate positioning of one or both feet.(b) "Abduction Position, Custom Fitted Orthosis" means a custom-fitted shoulder-elbow-wrist-hand orthosis designed specifically to control abduction of these areas.(c) "Above Elbow" means trans-humeral as it relates to prostheses or levels of amputation across the long axis of the humerus.(d) "Above Knee" means trans-femoral as it relates to prostheses or levels of amputation across the long axis of the femur.(e) "Activities of Daily Living" or "ADLs" means those activities performed by an individual for essential living purposes, such as bathing, eating, toileting, ambulation, dressing and transferring.(f) "Addition" means any provision that is different from or not included in the base appliance that enhances or facilitates the intended function of the base appliance.(g) "Ancillary Orthotic Device" means an orthosis that is not otherwise included under any other orthotic grouping.(h) "Ankle-Foot Orthosis" means an orthosis that traverses the ankle and foot.(i) "Anterior-Posterior-Lateral Control Orthosis" means an orthosis that traverses the cervical, thoracic, lumbar or sacral areas to provide control of anterior, posterior and lateral motion to these areas of the spine.(j) "Appliance" means an orthosis or prosthesis that is applied to the appropriate body part to modify or replace the structural and functional characteristic of the neuromuscular and skeletal systems.(k) "Attachment" means any provision that is different from or not included in the base appliance that changes the base appliance's function beyond its originally intended function.(l) "Backup Appliance" means another of the same prosthetic or orthotic appliance for the purpose of being used in the event the patient's primary appliance is unable to be used.(m) "Base Appliance" means an appliance that provides the essential or fundamental function designed for the appliance.(n) "Below Elbow" means trans-radial as it relates to prostheses or levels of amputation across the long axis of the radius or ulna.(o) "Below Knee" means trans-tibial as it relates to prostheses or levels of amputation across the long axis of the tibia or fibula.(p) "Bilateral" means being of, or pertaining to both sides of the body.(q) "Body Jacket" means a rigid or semi-rigid orthosis that encompasses the torso to limit spinal motion.(r) "Cervical and Multiple Post Collar Orthosis" means a collar that fits around the neck to provide support and protection to the cervical spine.(s) "Cervical Orthosis" means an orthosis that traverses the cervical vertebrae.(t) "Cervical-Thoracic-Lumbar-Sacral Orthosis" means an orthotic grouping that includes sacroiliac orthoses, lumbar orthoses, lumbar-sacral orthoses, and anterior-posterior-lateral control orthoses; each individual orthosis traverses the cervical, thoracic, lumbar or sacral vertebrae.(u) "Cervical-Thoracic Orthosis" means an orthosis that traverses the cervical and thoracic vertebrae.(v) "Compression Burn Garment" means a stocking worn over a burned area(s) of the body that provides pressure as an aid to healing and reduction of scar tissue.(w) "Computer Aided Design/Computer Aided Manufacture Model" or "CAD/CAM Model" means an appliance fabricated with the aid of a three-dimensional positive or negative image or digital scanning of the patient's limb(s).(x) "Conventional Shoes" means non-orthopedic shoes.(y) "Cranial Orthosis" means a helmet that fits over the head of the patient for the primary purpose of molding the skull, and may provide some protection.(z) "Custom Fabricated Appliance" or "Custom Fabrication" means an appliance constructed for a specific patient by obtaining individual measurements, fashioning a pattern or creating a mold, using either a plaster cast, or with a positive or negative impression or using a scanning device.(aa) "Custom Fitted Appliance" means a prefabricated appliance that requires individual adjustment, alteration or assembly for safe and optimal application to a specific patient.(bb) "Custom Made" means the same as custom fabricated.(cc) "Date of Service" means the date the appliance was received by the patient.(dd) "Definitive Prosthetic Appliance" or "Definitive Prosthesis" means a prosthesis intended for long-term use containing components suitable for the full range of functional activities the amputee may be able to perform.(ee) "Device" means the same as appliance.(ff) "Direct Formed Appliance" means an appliance in which material is molded over the involved portion of the patient's body and ultimately becomes the appliance or an essential part of the appliance for that patient.(gg) "Dynamic Flexor Hinge, Reciprocal Wrist Extension/Flexion, Finger Flexion/Extension Orthosis" means a custom-made orthosis that traverses the wrist, hand and fingers to control extension and flexion of these areas.(hh) "Elbow Orthosis" means an orthosis that traverses the elbow.(ii) "Endoskeletal Prosthesis" means a prosthesis that is composed of an internal pylon system that provides structural integrity to the appliance and provides the prosthesis' main support by accepting the stress of the body's weight or functional activities.(jj) "Exoskeletal Prosthesis" means a prosthesis that is composed of a rigid external shell that provides structural integrity to the appliance and provides the prosthesis' main support by accepting the stress of the body's weight or functional activity.(kk) "External Power" means an orthosis or prosthesis that relies on a force other than that from the user's body to operate, such as from a battery powered motor.(ll) "Finger Orthosis" means an orthosis that traverses the finger.(mm) "Foot Orthosis" means an orthosis that traverses the foot.(nn) "Foot Prosthesis" means a prosthesis that replaces all or part of an amputated or deformed foot.(oo) "Fracture Orthosis" means an orthosis that traverses the upper or lower extremity to stabilize and support an extremity fracture.(pp) "Gradient Compression Stocking" means a garment with variable degrees of pressure, typically from highest pressure in the distal parts of the garment with a lower pressure in the proximal parts of the garment.(qq) "Grouping," when used with "orthotic" or "prosthetic" means more than one appliance or service that has been placed together in the same procedural code classification.(rr) "Hallux-Valgus Splint" means a device that fits over the big toe to maintain proper anatomical position of the toe.(ss) "Halo Procedure" means a metal structure connected to a skull ring with pins inserted into the skull and attached to a body jacket or other orthosis to hold the metal structure in place in order to immobilize the cervical spine.(tt) "Hand-Finger Orthosis" means an orthosis that traverses the hand and finger areas.(uu) "Hand Orthosis" means an orthosis that encompasses the whole or any part of the hand.(vv) "Hemipelvectomy Prosthesis" means a prosthesis for an amputation that is performed through a portion of the pelvis.(ww) "Hip Disarticulation Prosthesis" means a prosthesis for an amputation through the hip joint.(xx) "Hip-Knee-Ankle-Foot Orthosis" means an orthosis that traverses the hip, knee, ankle and foot areas.(yy) "Hip Orthosis" means an orthosis that traverses the hip area.(zz) "Immediate and Early Post Surgical Procedure" means amputation and prosthetic appliance management that begins immediately or very soon following surgical closure of the original amputation wound or a residual limb revision wound.(aaa) "Infant Immobilizer" means a device that restricts movement of the infant in order to stabilize the infant's cervical and upper thoracic spine and airway.(bbb) "Initial Prosthesis" means a direct formed temporary appliance provided as part of the immediate and early post surgical and prosthetic appliance management.(ccc) "Insert" means the same as foot orthosis.(ddd) "Instrumental Activities of Daily Living" or "IADLs" means those activities that support activities of daily living and the capacity for normal activity, including employment, such as outside mobility, shopping, transportation, housework, hygiene, laundry, meal preparation and medication management.(eee) "Knee-Ankle-Foot Orthosis" means an orthosis that traverses the knee, ankle and foot areas.(fff) "Knee Disarticulation Prosthesis" means a prosthesis for an amputation through the knee joint.(ggg) "Knee Orthosis" means an orthosis that traverses the knee area.(hhh) "Legg-Perthes Orthosis" means a hip orthosis that is designed especially for the patient with Legg-Perthes deformity.(iii) "Lumbar Orthosis" means an orthosis that traverses the lumbar area.(jjj) "Lumbar-Sacral Orthosis" means an orthosis that traverses the lumbar and sacral areas.(kkk) "Mobile Arm Support" means an abduction position, custom fitted orthosis that is designed specifically for a patient who requires support attached to a wheelchair, chair or table.(lll) "Molded to the Patient" means a custom fabricated appliance.(mmm) "Off-the-Shelf Appliance" means an orthotic or prosthetic appliance that fits a patient without assembly or structural modification.(nnn) "Orthopedic Footwear" means an orthotic grouping that includes stock orthopedic shoes, stock conventional shoes and custom-made orthopedic shoes.(ooo) "Orthopedic Shoes" means an orthotic grouping that includes Hallux-Valgus splint, abduction and rotation bars, orthopedic footwear and shoe modifications of stock orthopedic shoes and stock conventional shoes; or shoes that have features that are designed for a medical condition(s) of the foot or ankle, such as extra room or depth, support, or ability to be modified.(ppp) "Orthosis" means an externally applied appliance used to modify the structural and functional characteristics of the neuromuscular and skeletal systems.(qqq) "Orthotic Devices -- Lower Limb (Extremity)" means an orthotic grouping that includes hip orthoses, Legg Perthes orthoses, knee orthoses, ankle-foot orthoses, knee-ankle-foot orthoses -- or any combination, torsion control: hip-knee-ankle-foot orthoses, torsion control: hip-knee-ankle-foot orthoses (tibial fracture casts), torsion control: hip-knee-ankle-foot orthoses (femoral fracture casts), reciprocating gait orthoses, and orthotic devices -- lower limb (extremity) (additions to lower extremity orthoses).(rrr) "Orthotic Devices -- Lower Limb (Extremity) (Additions to Lower Extremity Orthoses)" means an orthotic grouping that includes additions to fracture orthoses, additions to lower extremity orthoses: shoe-ankle-shin-knee, additions to straight knee or offset knee joints (knee joints), additions: thigh-weight bearing -- gluteal/ischial weight bearing, additions: pelvic and thoracic control, additions: general, and custom foot orthoses.(sss) "Orthotic Devices -- Scoliosis Procedures" means an orthotic grouping that includes cervical-thoracic-lumbar-sacral orthoses, thoracic-lumbar-sacral orthoses (low profile) and other scoliosis procedures (body jackets).(ttt) "Orthotic Devices -- Upper Limb" means an orthotic grouping that includes shoulder orthoses; elbow orthoses; wrist-hand-finger orthoses; additions to upper limb orthoses; dynamic flexor hinge, reciprocal wrist extension/flexion, finger flexion/extension orthoses; external power orthoses and other wrist-hand-finger orthoses -- custom fitted.(uuu) "Prefabricated Appliance" means an appliance that has been manufactured from standard molds or patterns with no specific patient in mind.(vvv) "Preparatory Prosthesis" means a temporary prosthetic appliance utilized to prepare the residual limb for eventual fitting and to evaluate the appropriateness of selected technology and the patient's ability to use a definitive prosthesis.(www) "Primary Appliance" means the principal appliance intended to be used by the patient.(xxx) "Procedure" or "Special Procedure" means an appliance, addition, attachment, adaptation or feature that is designed to meet a specific medical need.(yyy) "Prosthesis" means an externally applied appliance used to replace wholly, or in part, an absent or deficient body part.(zzz) "Reciprocating Gait Orthosis" means a bilateral hip-knee-ankle-foot orthosis that transfers motion energy from one leg to the other, aiding or enabling ambulation.(aaaa) "Replacement Glove" means a passive partial hand prosthesis that is made from an existing mold or a cosmetic cover for a passive or functional hand prosthesis.(bbbb) "Rigid" means not bending; inflexible during normal use and resistant to normal use forces.(cccc) "Sacroiliac Orthosis" means an orthosis that traverses the pelvic and sacral areas.(dddd) "Scoliosis Orthosis" means the same as scoliosis procedure.(eeee) "Scoliosis Procedure" means a spinal orthosis that treats a curvature or other instability of the spine.(ffff) "Semi-Rigid" means partially rigid; having some rigid elements.(gggg) "Services" means activities, including medical examinations, that are related to the provision of prosthetic and orthotic appliances, such as repairs, laboratory work necessary for construction of the appliance, casting and cast changes, realignment or adjustment of appliances, application of dressings, measuring or fitting for appliances, training the patient on the use and care of the appliance and delivery of appliances.(hhhh) "Shoe Modification" means an addition, modification or service to an off-the-shelf or custom-made shoe to improve its functionality.(iiii) "Shoe Modifications of Stock Orthopedic Shoes and Stock Conventional Shoes" means an orthotic grouping that includes shoe modifications -- lifts, shoe modifications -- wedges, shoe modifications -- heels, orthopedic shoe additions, and transfer or replacement.(jjjj) "Shoulder-Elbow-Wrist-Hand Orthosis" means an orthotic grouping that includes abduction position, custom fitted orthoses; mobile arm supports; additions to mobile arm supports and fracture orthoses; or an orthosis that traverses the shoulder, elbow, wrist and hand areas.(kkkk) "Shoulder Orthosis" means an orthosis that traverses the shoulder.(llll) "Spinal Orthosis" means an orthotic grouping where each individual orthosis traverses some part of the spine that includes cranial orthoses, cervical and multiple post collar orthoses, thoracic orthoses (rib belts), thoracic orthoses (anterior-posterior-lateral-rotary control), thoracic orthoses (triplanar control -- modular segmented spinal system [prefabricated]), thoracic orthoses (triplanar control -- rigid frame), and thoracic orthoses (triplanar control -- rigid plastic shell).(mmmm) "Stock" when used with "orthopedic shoes" or "conventional shoes" means a shoe that fits a patient without assembly or structural modification.(nnnn) "Tension Based Scoliosis Orthosis" means an orthosis that utilizes elastic strapping linked to control pads intended for treatment of adolescent idiopathic scoliosis.(oooo) "Thoracic-Hip-Knee-Ankle Orthosis" means an orthosis that traverses the thoracic, hip, knee and ankle areas.(pppp) "Thoracic-Lumbar-Sacral Orthosis" means an orthosis that traverses the thoracic, lumbar and sacral areas.(qqqq) "Thoracic Orthosis" means an orthosis that traverses the thoracic area.(rrrr) "Torsion Control Orthosis" means an orthosis that controls rotation of the joint in which it traverses.(ssss) "Truss" means an orthosis used to reduce a hernia via direct external abdominal pressure.(tttt) "Wrist-Hand-Finger Orthosis" means an orthosis that traverses the wrist, hand and finger areas.(uuuu) "Wrist-Hand Orthosis" means an orthosis that traverses the wrist and hand areas.(vvvv) "Wrist Orthosis" means an orthosis that traverses the wrist.Cal. Code Regs. Tit. 22, § 51161
1. New section filed 5-14-76 as an emergency; effective upon filing (Register 76, No. 20).
2. Certificate of Compliance filed 9-8-76 (Register 76, No. 37).
3. Change without regulatory effect of NOTE (Register 86, No. 49).
4. Amendment of section heading, section and NOTE filed 10-2-2015; operative 1-1-2016 (Register 2015, No. 40). Note: Authority cited: Section 20, Health and Safety Code; and Sections 10725, 14103.7 and 14124.5, Welfare and Institutions Code. Reference: Sections 14103.7, 14105.21, 14131, 14132, 14133.3 and 14133.9, Welfare and Institutions Code.
1. New section filed 5-14-76 as an emergency; effective upon filing (Register 76, No. 20).
2. Certificate of Compliance filed 9-8-76 (Register 76, No. 37).
3. Change without regulatory effect of NOTE (Register 86, No. 49).
4. Amendment of section heading, section and Note filed 10-2-2015; operative 1/1/2016 (Register 2015, No. 40).