HCPCS L-Codes
Orthotic and Prosthetic Procedures, Devices

Braces; trusses; and artifical legs, arms, and eyes are covered when furnished incident to a physician’s services or on a physician’s order. A brace includes rigid and semirigid devices used for the purpose of supporting a weak or deformed body member or restricting or eliminating motion in a diseased or injured part of the body. Back braces include, but are not limited to, sacroiliac, sacrolumbar, dorsolumbar corsets, and belts. Stump stockings and harnesses (including replacements) are also covered when these appliances are essential to the effective use of an artificial limb. Adjustments to an artificial limb or other appliance required by wear or by a change in the patient’s condition are covered when ordered by a physician. Adjustments, repairs, and replacements are covered so long as the device continues to be medically required.

  • L3460

    Heel, new rubber, standard

  • L3465

    Heel, thomas with wedge

  • L3470

    Heel, thomas extended to ball

  • L3480

    Heel, pad and depression for spur

  • L3485

    Heel, pad, removable for spur

  • L3500

    Orthopedic shoe addition, insole, leather

  • L3510

    Orthopedic shoe addition, insole, rubber

  • L3520

    Orthopedic shoe addition, insole, felt covered with leather

  • L3530

    Orthopedic shoe addition, sole, half

  • L3540

    Orthopedic shoe addition, sole, full
  • Continued

  • L3550

    Orthopedic shoe addition, toe tap standard

  • L3560

    Orthopedic shoe addition, toe tap, horseshoe

  • L3570

    Orthopedic shoe addition, special extension to instep (leather with eyelets)

  • L3580

    Orthopedic shoe addition, convert instep to velcro closure

  • L3590

    Orthopedic shoe addition, convert firm shoe counter to soft counter

  • L3595

    Orthopedic shoe addition, march bar

  • L3600

    Transfer of an orthosis from one shoe to another, caliper plate, existing

  • L3610

    Transfer of an orthosis from one shoe to another, caliper plate, new

  • L3620

    Transfer of an orthosis from one shoe to another, solid stirrup, existing

  • L3630

    Transfer of an orthosis from one shoe to another, solid stirrup, new

  • L3640

    Transfer of an orthosis from one shoe to another, dennis browne splint (riveton), both shoes

  • L3649

    Orthopedic shoe, modification, addition or transfer, not otherwise specified

  • L3650

    Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf

  • L3660

    Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf

  • L3670

    Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf

  • L3671

    Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

  • L3674

    Shoulder orthosis, abduction positioning (airplane design), thoracic component and support bar, with or without nontorsion joint/turnbuckle, may include soft interface, straps, custom fabricated, includes fitting and adjustment

  • L3675

    Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf

  • L3677

    Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

  • L3678

    Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated, off-the-shelf
  • Continued

  • L3702

    Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

  • L3710

    Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf

  • L3720

    Elbow orthosis, double upright with forearm/arm cuffs, free motion, custom fabricated

  • L3730

    Elbow orthosis, double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated

  • L3740

    Elbow orthosis, double upright with forearm/arm cuffs, adjustable position lock with active control, custom fabricated

  • L3760

    Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

  • L3761

    Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, off-the-shelf

  • L3762

    Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf

  • L3763

    Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

  • L3764

    Elbow wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

  • L3765

    Elbow wrist hand finger orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

  • L3766

    Elbow wrist hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

  • L3806

    Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment

  • L3807

    Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

  • L3808

    Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment

  • L3809

    Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type

  • L3891

    Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each

  • L3900

    Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, wrist or finger driven, custom fabricated

  • L3901

    Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom fabricated

  • L3904

    Wrist hand finger orthosis, external powered, electric, custom fabricated