L1906 ankle brace letter of medical necessity documentaion 2025

1. Click ‘Get Form’ to open the l1906 ankle brace letter of medical necessity document in our editor.
2. Begin by entering the patient's name, HIC number, address, date of birth, and phone number in the designated fields.
3. Fill in the insurance information, including the insurance name and phone number.
4. Select the appropriate ankle foot stabilizer options from the list provided. Indicate if it is a left (LF), right (RF), or bilateral device.
5. In the 'Indications for use' section, check all applicable conditions that justify the need for the orthosis and enter relevant codes.
6. Provide a prognosis and estimated length of need in months. Ensure to include any specific notes regarding the patient's condition.
7. Have the physician sign and date the document, including their name, NPI number, and contact information.

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