HCPCS 'L' Codes (913)

Orthotic And Prosthetic Procedures, Devices

CodeDescription
L0112Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated
L0113Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment
L0120Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar)
L0130Cervical, flexible, thermoplastic collar, molded to patient
L0140Cervical, semi-rigid, adjustable (plastic collar)
L0150Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibular/occipital piece)
L0160Cervical, semi-rigid, wire frame occipital/mandibular support, prefabricated, off-the-shelf
L0170Cervical, collar, molded to patient model
L0172Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf
L0174Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf
L0180Cervical, multiple post collar, occipital/mandibular supports, adjustable
L0190Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars (somi, guilford, taylor types)
L0200Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars, and thoracic extension
L0220Thoracic, rib belt, custom fabricated
L0450Tlso, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf
L0452Tlso, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, custom fabricated
L0454Tlso flexible, provides trunk support, extends from sacrococcygeal junction to above t-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0455Tlso, flexible, provides trunk support, extends from sacrococcygeal junction to above t-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf
L0456Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0457Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated, off-the-shelf
L0458Tlso, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment
L0460Tlso, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0462Tlso, triplanar control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment
L0464Tlso, triplanar control, modular segmented spinal system, four rigid plastic shells, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment
L0466Tlso, sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0467Tlso, sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated, off-the-shelf
L0468Tlso, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal, and coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0469Tlso, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal and coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated, off-the-shelf
L0470Tlso, triplanar control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction to scapula, lateral strength provided by pelvic, thoracic, and lateral frame pieces, rotational strength provided by subclavicular extensions, restricts gross trunk motion in sagittal, coronal, and transverse planes, provides intracavitary pressure to reduce load on the intervertebral disks, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment
L0472Tlso, triplanar control, hyperextension, rigid anterior and lateral frame extends from symphysis pubis to sternal notch with two anterior components (one pubic and one sternal), posterior and lateral pads with straps and closures, limits spinal flexion, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment
L0480Tlso, triplanar control, one piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated
L0482Tlso, triplanar control, one piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated
L0484Tlso, triplanar control, two piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated
L0486Tlso, triplanar control, two piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated
L0488Tlso, triplanar control, one piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, prefabricated, includes fitting and adjustment
L0490Tlso, sagittal-coronal control, one piece rigid plastic shell, with overlapping reinforced anterior, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates at or before the t-9 vertebra, anterior extends from symphysis pubis to xiphoid, anterior opening, restricts gross trunk motion in sagittal and coronal planes, prefabricated, includes fitting and adjustment
L0491Tlso, sagittal-coronal control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal and coronal planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment
L0492Tlso, sagittal-coronal control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal and coronal planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment
L0621Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf
L0622Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated
L0623Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf
L0624Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels placed over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated
L0625Lumbar orthosis, flexible, provides lumbar support, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf
L0626Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0627Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0628Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf
L0629Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, custom fabricated
L0630Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0631Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0632Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, custom fabricated
L0633Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0634Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, custom fabricated
L0635Lumbar-sacral orthosis, sagittal-coronal control, lumbar flexion, rigid posterior frame/panel(s), lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, prefabricated, includes fitting and adjustment
L0636Lumbar sacral orthosis, sagittal-coronal control, lumbar flexion, rigid posterior frame/panels, lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, custom fabricated
L0637Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0638Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, custom fabricated
L0639Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0640Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, custom fabricated
L0641Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf
L0642Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf
L0643Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf
L0648Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf
L0649Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf
L0650Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf
L0651Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, prefabricated, off-the-shelf
L0700Cervical-thoracic-lumbar-sacral-orthoses (ctlso), anterior-posterior-lateral control, molded to patient model, (minerva type)
L0710Ctlso, anterior-posterior-lateral-control, molded to patient model, with interface material, (minerva type)
L0810Halo procedure, cervical halo incorporated into jacket vest
L0820Halo procedure, cervical halo incorporated into plaster body jacket
L0830Halo procedure, cervical halo incorporated into milwaukee type orthosis
L0859Addition to halo procedure, magnetic resonance image compatible systems, rings and pins, any material
L0861Addition to halo procedure, replacement liner/interface material
L0970Tlso, corset front
L0972Lso, corset front
L0974Tlso, full corset
L0976Lso, full corset
L0978Axillary crutch extension
L0980Peroneal straps, prefabricated, off-the-shelf, pair
L0982Stocking supporter grips, prefabricated, off-the-shelf, set of four (4)
L0984Protective body sock, prefabricated, off-the-shelf, each
L0999Addition to spinal orthosis, not otherwise specified
L1000Cervical-thoracic-lumbar-sacral orthosis (ctlso) (milwaukee), inclusive of furnishing initial orthosis, including model
L1001Cervical thoracic lumbar sacral orthosis, immobilizer, infant size, prefabricated, includes fitting and adjustment
L1005Tension based scoliosis orthosis and accessory pads, includes fitting and adjustment
L1010Addition to cervical-thoracic-lumbar-sacral orthosis (ctlso) or scoliosis orthosis, axilla sling
L1020Addition to ctlso or scoliosis orthosis, kyphosis pad
L1025Addition to ctlso or scoliosis orthosis, kyphosis pad, floating
L1030Addition to ctlso or scoliosis orthosis, lumbar bolster pad
L1040Addition to ctlso or scoliosis orthosis, lumbar or lumbar rib pad
L1050Addition to ctlso or scoliosis orthosis, sternal pad
L1060Addition to ctlso or scoliosis orthosis, thoracic pad
L1070Addition to ctlso or scoliosis orthosis, trapezius sling
L1080Addition to ctlso or scoliosis orthosis, outrigger
L1085Addition to ctlso or scoliosis orthosis, outrigger, bilateral with vertical extensions
L1090Addition to ctlso or scoliosis orthosis, lumbar sling
L1100Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather
L1110Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather, molded to patient model
L1120Addition to ctlso, scoliosis orthosis, cover for upright, each
L1200Thoracic-lumbar-sacral-orthosis (tlso), inclusive of furnishing initial orthosis only
L1210Addition to tlso, (low profile), lateral thoracic extension
L1220Addition to tlso, (low profile), anterior thoracic extension
L1230Addition to tlso, (low profile), milwaukee type superstructure
L1240Addition to tlso, (low profile), lumbar derotation pad
L1250Addition to tlso, (low profile), anterior asis pad
L1260Addition to tlso, (low profile), anterior thoracic derotation pad
L1270Addition to tlso, (low profile), abdominal pad
L1280Addition to tlso, (low profile), rib gusset (elastic), each
L1290Addition to tlso, (low profile), lateral trochanteric pad
L1300Other scoliosis procedure, body jacket molded to patient model
L1310Other scoliosis procedure, post-operative body jacket
L1320Thoracic, pectus carinatum orthosis, sternal compression, rigid circumferential frame with anterior and posterior rigid pads, custom fabricated
L1499Spinal orthosis, not otherwise specified
L1600Hip orthosis, abduction control of hip joints, flexible, frejka type with cover, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an inidividual with expertise
L1610Hip orthosis, abduction control of hip joints, flexible, (frejka cover only), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L1620Hip orthosis, abduction control of hip joints, flexible, (pavlik harness), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L1630Hip orthosis, abduction control of hip joints, semi-flexible (von rosen type), custom fabricated
L1640Hip orthosis, abduction control of hip joints, static, pelvic band or spreader bar, thigh cuffs, custom fabricated
L1650Hip orthosis, abduction control of hip joints, static, adjustable, (ilfled type), prefabricated, includes fitting and adjustment
L1652Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, includes fitting and adjustment, any type
L1660Hip orthosis, abduction control of hip joints, static, plastic, prefabricated, includes fitting and adjustment
L1680Hip orthosis, abduction control of hip joints, dynamic, pelvic control, adjustable hip motion control, thigh cuffs (rancho hip action type), custom fabricated
L1681Hip orthosis, bilateral hip joints and thigh cuffs, adjustable flexion, extension, abduction control of hip joint, postoperative hip abduction type, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L1685Hip orthosis, abduction control of hip joint, postoperative hip abduction type, custom fabricated
L1686Hip orthosis, abduction control of hip joint, postoperative hip abduction type, prefabricated, includes fitting and adjustment
L1690Combination, bilateral, lumbo-sacral, hip, femur orthosis providing adduction and internal rotation control, prefabricated, includes fitting and adjustment
L1700Legg perthes orthosis, (toronto type), custom fabricated
L1710Legg perthes orthosis, (newington type), custom fabricated
L1720Legg perthes orthosis, trilateral, (tachdijan type), custom fabricated
L1730Legg perthes orthosis, (scottish rite type), custom fabricated
L1755Legg perthes orthosis, (patten bottom type), custom fabricated
L1810Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L1812Knee orthosis, elastic with joints, prefabricated, off-the-shelf
L1820Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, includes fitting and adjustment
L1830Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf
L1831Knee orthosis, locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment
L1832Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L1833Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf
L1834Knee orthosis, without knee joint, rigid, custom fabricated
L1836Knee orthosis, rigid, without joint(s), includes soft interface material, prefabricated, off-the-shelf
L1840Knee orthosis, derotation, medial-lateral, anterior cruciate ligament, custom fabricated
L1843Knee orthosis, 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 item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L1844Knee orthosis, 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, custom fabricated
L1845Knee orthosis, 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 item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L1846Knee orthosis, 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, custom fabricated
L1847Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L1848Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated, off-the-shelf
L1850Knee orthosis, swedish type, prefabricated, off-the-shelf
L1851Knee 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-shelf
L1852Knee 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
L1860Knee orthosis, modification of supracondylar prosthetic socket, custom fabricated (sk)
L1900Ankle foot orthosis, spring wire, dorsiflexion assist calf band, custom fabricated
L1902Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf
L1904Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated
L1906Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf
L1907Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated
L1910Ankle foot orthosis, posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment
L1920Ankle foot orthosis, single upright with static or adjustable stop (phelps or perlstein type), custom fabricated
L1930Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment
L1932Afo, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, includes fitting and adjustment
L1940Ankle foot orthosis, plastic or other material, custom fabricated
L1945Ankle foot orthosis, plastic, rigid anterior tibial section (floor reaction), custom fabricated
L1950Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic, custom fabricated
L1951Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, includes fitting and adjustment
L1960Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L1970Ankle foot orthosis, plastic with ankle joint, custom fabricated
L1971Ankle foot orthosis, plastic or other material with ankle joint, prefabricated, includes fitting and adjustment
L1980Ankle foot orthosis, single upright free plantar dorsiflexion, solid stirrup, calf band/cuff (single bar 'bk' orthosis), custom fabricated
L1990Ankle foot orthosis, double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar 'bk' orthosis), custom fabricated
L2000Knee ankle foot orthosis, single upright, free knee, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar 'ak' orthosis), custom fabricated
L2005Knee ankle foot orthosis, any material, single or double upright, stance control, automatic lock and swing phase release, any type activation, includes ankle joint, any type, custom fabricated
L2006Knee ankle foot device, any material, single or double upright, swing and stance phase microprocessor control with adjustability, includes all components (e.g., sensors, batteries, charger), any type activation, with or without ankle joint(s), custom fabricated
L2010Knee ankle foot orthosis, single upright, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar 'ak' orthosis), without knee joint, custom fabricated
L2020Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs (double bar 'ak' orthosis), custom fabricated
L2030Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs, (double bar 'ak' orthosis), without knee joint, custom fabricated
L2034Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, medial lateral rotation control, with or without free motion ankle, custom fabricated
L2035Knee ankle foot orthosis, full plastic, static (pediatric size), without free motion ankle, prefabricated, includes fitting and adjustment
L2036Knee ankle foot orthosis, full plastic, double upright, with or without free motion knee, with or without free motion ankle, custom fabricated
L2037Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, with or without free motion ankle, custom fabricated
L2038Knee ankle foot orthosis, full plastic, with or without free motion knee, multi-axis ankle, custom fabricated
L2040Hip knee ankle foot orthosis, torsion control, bilateral rotation straps, pelvic band/belt, custom fabricated
L2050Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, hip joint, pelvic band/belt, custom fabricated
L2060Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, ball bearing hip joint, pelvic band/ belt, custom fabricated
L2070Hip knee ankle foot orthosis, torsion control, unilateral rotation straps, pelvic band/belt, custom fabricated
L2080Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, hip joint, pelvic band/belt, custom fabricated
L2090Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, ball bearing hip joint, pelvic band/ belt, custom fabricated
L2106Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, thermoplastic type casting material, custom fabricated
L2108Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, custom fabricated
L2112Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment
L2114Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment
L2116Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, rigid, prefabricated, includes fitting and adjustment
L2126Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, thermoplastic type casting material, custom fabricated
L2128Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, custom fabricated
L2132Kafo, fracture orthosis, femoral fracture cast orthosis, soft, prefabricated, includes fitting and adjustment
L2134Kafo, fracture orthosis, femoral fracture cast orthosis, semi-rigid, prefabricated, includes fitting and adjustment
L2136Kafo, fracture orthosis, femoral fracture cast orthosis, rigid, prefabricated, includes fitting and adjustment
L2180Addition to lower extremity fracture orthosis, plastic shoe insert with ankle joints
L2182Addition to lower extremity fracture orthosis, drop lock knee joint
L2184Addition to lower extremity fracture orthosis, limited motion knee joint
L2186Addition to lower extremity fracture orthosis, adjustable motion knee joint, lerman type
L2188Addition to lower extremity fracture orthosis, quadrilateral brim
L2190Addition to lower extremity fracture orthosis, waist belt
L2192Addition to lower extremity fracture orthosis, hip joint, pelvic band, thigh flange, and pelvic belt
L2200Addition to lower extremity, limited ankle motion, each joint
L2210Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint
L2220Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint
L2230Addition to lower extremity, split flat caliper stirrups and plate attachment
L2232Addition to lower extremity orthosis, rocker bottom for total contact ankle foot orthosis, for custom fabricated orthosis only
L2240Addition to lower extremity, round caliper and plate attachment
L2250Addition to lower extremity, foot plate, molded to patient model, stirrup attachment
L2260Addition to lower extremity, reinforced solid stirrup (scott-craig type)
L2265Addition to lower extremity, long tongue stirrup
L2270Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad
L2275Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined
L2280Addition to lower extremity, molded inner boot
L2300Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2310Addition to lower extremity, abduction bar-straight
L2320Addition to lower extremity, non-molded lacer, for custom fabricated orthosis only
L2330Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only
L2335Addition to lower extremity, anterior swing band
L2340Addition to lower extremity, pre-tibial shell, molded to patient model
L2350Addition to lower extremity, prosthetic type, (bk) socket, molded to patient model, (used for 'ptb' 'afo' orthoses)
L2360Addition to lower extremity, extended steel shank
L2370Addition to lower extremity, patten bottom
L2375Addition to lower extremity, torsion control, ankle joint and half solid stirrup
L2380Addition to lower extremity, torsion control, straight knee joint, each joint
L2385Addition to lower extremity, straight knee joint, heavy duty, each joint
L2387Addition to lower extremity, polycentric knee joint, for custom fabricated knee ankle foot orthosis, each joint
L2390Addition to lower extremity, offset knee joint, each joint
L2395Addition to lower extremity, offset knee joint, heavy duty, each joint
L2397Addition to lower extremity orthosis, suspension sleeve
L2405Addition to knee joint, drop lock, each
L2415Addition to knee lock with integrated release mechanism (bail, cable, or equal), any material, each joint
L2425Addition to knee joint, disc or dial lock for adjustable knee flexion, each joint
L2430Addition to knee joint, ratchet lock for active and progressive knee extension, each joint
L2492Addition to knee joint, lift loop for drop lock ring
L2500Addition to lower extremity, thigh/weight bearing, gluteal/ ischial weight bearing, ring
L2510Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, molded to patient model
L2520Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, custom fitted
L2525Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim molded to patient model
L2526Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim, custom fitted
L2530Addition to lower extremity, thigh-weight bearing, lacer, non-molded
L2540Addition to lower extremity, thigh/weight bearing, lacer, molded to patient model
L2550Addition to lower extremity, thigh/weight bearing, high roll cuff
L2570Addition to lower extremity, pelvic control, hip joint, clevis type two position joint, each
L2580Addition to lower extremity, pelvic control, pelvic sling
L2600Addition to lower extremity, pelvic control, hip joint, clevis type, or thrust bearing, free, each
L2610Addition to lower extremity, pelvic control, hip joint, clevis or thrust bearing, lock, each
L2620Addition to lower extremity, pelvic control, hip joint, heavy duty, each
L2622Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each
L2624Addition to lower extremity, pelvic control, hip joint, adjustable flexion, extension, abduction control, each
L2627Addition to lower extremity, pelvic control, plastic, molded to patient model, reciprocating hip joint and cables
L2628Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables
L2630Addition to lower extremity, pelvic control, band and belt, unilateral
L2640Addition to lower extremity, pelvic control, band and belt, bilateral
L2650Addition to lower extremity, pelvic and thoracic control, gluteal pad, each
L2660Addition to lower extremity, thoracic control, thoracic band
L2670Addition to lower extremity, thoracic control, paraspinal uprights
L2680Addition to lower extremity, thoracic control, lateral support uprights
L2750Addition to lower extremity orthosis, plating chrome or nickel, per bar
L2755Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only
L2760Addition to lower extremity orthosis, extension, per extension, per bar (for lineal adjustment for growth)
L2768Orthotic side bar disconnect device, per bar
L2780Addition to lower extremity orthosis, non-corrosive finish, per bar
L2785Addition to lower extremity orthosis, drop lock retainer, each
L2795Addition to lower extremity orthosis, knee control, full kneecap
L2800Addition to lower extremity orthosis, knee control, knee cap, medial or lateral pull, for use with custom fabricated orthosis only
L2810Addition to lower extremity orthosis, knee control, condylar pad
L2820Addition to lower extremity orthosis, soft interface for molded plastic, below knee section
L2830Addition to lower extremity orthosis, soft interface for molded plastic, above knee section
L2840Addition to lower extremity orthosis, tibial length sock, fracture or equal, each
L2850Addition to lower extremity orthosis, femoral length sock, fracture or equal, each
L2861Addition to lower extremity joint, knee or ankle, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each
L2999Lower extremity orthoses, not otherwise specified
L3000Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each
L3001Foot, insert, removable, molded to patient model, spenco, each
L3002Foot, insert, removable, molded to patient model, plastazote or equal, each
L3003Foot, insert, removable, molded to patient model, silicone gel, each
L3010Foot, insert, removable, molded to patient model, longitudinal arch support, each
L3020Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each
L3030Foot, insert, removable, formed to patient foot, each
L3031Foot, insert/plate, removable, addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, each
L3040Foot, arch support, removable, premolded, longitudinal, each
L3050Foot, arch support, removable, premolded, metatarsal, each
L3060Foot, arch support, removable, premolded, longitudinal/ metatarsal, each
L3070Foot, arch support, non-removable attached to shoe, longitudinal, each
L3080Foot, arch support, non-removable attached to shoe, metatarsal, each
L3090Foot, arch support, non-removable attached to shoe, longitudinal/metatarsal, each
L3100Hallus-valgus night dynamic splint, prefabricated, off-the-shelf
L3140Foot, abduction rotation bar, including shoes
L3150Foot, abduction rotation bar, without shoes
L3160Foot, adjustable shoe-styled positioning device
L3161Foot, adductus positioning device, adjustable
L3170Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each
L3201Orthopedic shoe, oxford with supinator or pronator, infant
L3202Orthopedic shoe, oxford with supinator or pronator, child
L3203Orthopedic shoe, oxford with supinator or pronator, junior
L3204Orthopedic shoe, hightop with supinator or pronator, infant
L3206Orthopedic shoe, hightop with supinator or pronator, child
L3207Orthopedic shoe, hightop with supinator or pronator, junior
L3208Surgical boot, each, infant
L3209Surgical boot, each, child
L3211Surgical boot, each, junior
L3212Benesch boot, pair, infant
L3213Benesch boot, pair, child
L3214Benesch boot, pair, junior
L3215Orthopedic footwear, ladies shoe, oxford, each
L3216Orthopedic footwear, ladies shoe, depth inlay, each
L3217Orthopedic footwear, ladies shoe, hightop, depth inlay, each
L3219Orthopedic footwear, mens shoe, oxford, each
L3221Orthopedic footwear, mens shoe, depth inlay, each
L3222Orthopedic footwear, mens shoe, hightop, depth inlay, each
L3224Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthosis)
L3225Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis)
L3230Orthopedic footwear, custom shoe, depth inlay, each
L3250Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each
L3251Foot, shoe molded to patient model, silicone shoe, each
L3252Foot, shoe molded to patient model, plastazote (or similar), custom fabricated, each
L3253Foot, molded shoe plastazote (or similar) custom fitted, each
L3254Non-standard size or width
L3255Non-standard size or length
L3257Orthopedic footwear, additional charge for split size
L3260Surgical boot/shoe, each
L3265Plastazote sandal, each
L3300Lift, elevation, heel, tapered to metatarsals, per inch
L3310Lift, elevation, heel and sole, neoprene, per inch
L3320Lift, elevation, heel and sole, cork, per inch
L3330Lift, elevation, metal extension (skate)
L3332Lift, elevation, inside shoe, tapered, up to one-half inch
L3334Lift, elevation, heel, per inch
L3340Heel wedge, sach
L3350Heel wedge
L3360Sole wedge, outside sole
L3370Sole wedge, between sole
L3380Clubfoot wedge
L3390Outflare wedge
L3400Metatarsal bar wedge, rocker
L3410Metatarsal bar wedge, between sole
L3420Full sole and heel wedge, between sole
L3430Heel, counter, plastic reinforced
L3440Heel, counter, leather reinforced
L3450Heel, sach cushion type
L3455Heel, new leather, standard
L3460Heel, new rubber, standard
L3465Heel, thomas with wedge
L3470Heel, thomas extended to ball
L3480Heel, pad and depression for spur
L3485Heel, pad, removable for spur
L3500Orthopedic shoe addition, insole, leather
L3510Orthopedic shoe addition, insole, rubber
L3520Orthopedic shoe addition, insole, felt covered with leather
L3530Orthopedic shoe addition, sole, half
L3540Orthopedic shoe addition, sole, full
L3550Orthopedic shoe addition, toe tap standard
L3560Orthopedic shoe addition, toe tap, horseshoe
L3570Orthopedic shoe addition, special extension to instep (leather with eyelets)
L3580Orthopedic shoe addition, convert instep to velcro closure
L3590Orthopedic shoe addition, convert firm shoe counter to soft counter
L3595Orthopedic shoe addition, march bar
L3600Transfer of an orthosis from one shoe to another, caliper plate, existing
L3610Transfer of an orthosis from one shoe to another, caliper plate, new
L3620Transfer of an orthosis from one shoe to another, solid stirrup, existing
L3630Transfer of an orthosis from one shoe to another, solid stirrup, new
L3640Transfer of an orthosis from one shoe to another, dennis browne splint (riveton), both shoes
L3649Orthopedic shoe, modification, addition or transfer, not otherwise specified
L3650Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf
L3660Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf
L3670Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf
L3671Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3674Shoulder 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
L3675Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf
L3677Shoulder 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
L3678Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated, off-the-shelf
L3702Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3710Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf
L3720Elbow orthosis, double upright with forearm/arm cuffs, free motion, custom fabricated
L3730Elbow orthosis, double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated
L3740Elbow orthosis, double upright with forearm/arm cuffs, adjustable position lock with active control, custom fabricated
L3760Elbow 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
L3761Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, off-the-shelf
L3762Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf
L3763Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3764Elbow wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3765Elbow wrist hand finger orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3766Elbow wrist hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3806Wrist 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
L3807Wrist 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
L3808Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment
L3809Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type
L3891Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each
L3900Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, wrist or finger driven, custom fabricated
L3901Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom fabricated
L3904Wrist hand finger orthosis, external powered, electric, custom fabricated
L3905Wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3906Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3908Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf
L3912Hand finger orthosis (hfo), flexion glove with elastic finger control, prefabricated, off-the-shelf
L3913Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3915Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, 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
L3916Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf
L3917Hand orthosis, metacarpal fracture orthosis, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L3918Hand orthosis, metacarpal fracture orthosis, prefabricated, off-the-shelf
L3919Hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3921Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3923Hand finger orthosis, 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
L3924Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, off-the-shelf
L3925Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf
L3927Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), without joint/spring, extension/flexion (e.g., static or ring type), may include soft interface material, prefabricated, off-the-shelf
L3929Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L3930Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, off-the-shelf
L3931Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, includes fitting and adjustment
L3933Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment
L3935Finger orthosis, nontorsion joint, may include soft interface, custom fabricated, includes fitting and adjustment
L3956Addition of joint to upper extremity orthosis, any material; per joint
L3960Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment
L3961Shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3962Shoulder elbow wrist hand orthosis, abduction positioning, erb's palsey design, prefabricated, includes fitting and adjustment
L3967Shoulder elbow wrist hand orthosis, abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3971Shoulder elbow wrist hand orthosis, shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3973Shoulder elbow wrist hand orthosis, abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3975Shoulder elbow wrist hand finger orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3976Shoulder elbow wrist hand finger orthosis, abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3977Shoulder elbow wrist hand finger orthosis, shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3978Shoulder elbow wrist hand finger orthosis, abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3980Upper extremity fracture orthosis, humeral, prefabricated, includes fitting and adjustment
L3981Upper extremity fracture orthosis, humeral, prefabricated, includes shoulder cap design, with or without joints, forearm section, may include soft interface, straps, includes fitting and adjustments
L3982Upper extremity fracture orthosis, radius/ulnar, prefabricated, includes fitting and adjustment
L3984Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment
L3995Addition to upper extremity orthosis, sock, fracture or equal, each
L3999Upper limb orthosis, not otherwise specified
L4000Replace girdle for spinal orthosis (ctlso or so)
L4002Replacement strap, any orthosis, includes all components, any length, any type
L4010Replace trilateral socket brim
L4020Replace quadrilateral socket brim, molded to patient model
L4030Replace quadrilateral socket brim, custom fitted
L4040Replace molded thigh lacer, for custom fabricated orthosis only
L4045Replace non-molded thigh lacer, for custom fabricated orthosis only
L4050Replace molded calf lacer, for custom fabricated orthosis only
L4055Replace non-molded calf lacer, for custom fabricated orthosis only
L4060Replace high roll cuff
L4070Replace proximal and distal upright for kafo
L4080Replace metal bands kafo, proximal thigh
L4090Replace metal bands kafo-afo, calf or distal thigh
L4100Replace leather cuff kafo, proximal thigh
L4110Replace leather cuff kafo-afo, calf or distal thigh
L4130Replace pretibial shell
L4205Repair of orthotic device, labor component, per 15 minutes
L4210Repair of orthotic device, repair or replace minor parts
L4350Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf
L4360Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L4361Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf
L4370Pneumatic full leg splint, prefabricated, off-the-shelf
L4386Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L4387Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf
L4392Replacement, soft interface material, static afo
L4394Replace soft interface material, foot drop splint
L4396Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L4397Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf
L4398Foot drop splint, recumbent positioning device, prefabricated, off-the-shelf
L4631Ankle foot orthosis, walking boot type, varus/valgus correction, rocker bottom, anterior tibial shell, soft interface, custom arch support, plastic or other material, includes straps and closures, custom fabricated
L5000Partial foot, shoe insert with longitudinal arch, toe filler
L5010Partial foot, molded socket, ankle height, with toe filler
L5020Partial foot, molded socket, tibial tubercle height, with toe filler
L5050Ankle, symes, molded socket, sach foot
L5060Ankle, symes, metal frame, molded leather socket, articulated ankle/foot
L5100Below knee, molded socket, shin, sach foot
L5105Below knee, plastic socket, joints and thigh lacer, sach foot
L5150Knee disarticulation (or through knee), molded socket, external knee joints, shin, sach foot
L5160Knee disarticulation (or through knee), molded socket, bent knee configuration, external knee joints, shin, sach foot
L5200Above knee, molded socket, single axis constant friction knee, shin, sach foot
L5210Above knee, short prosthesis, no knee joint ('stubbies'), with foot blocks, no ankle joints, each
L5220Above knee, short prosthesis, no knee joint ('stubbies'), with articulated ankle/foot, dynamically aligned, each
L5230Above knee, for proximal femoral focal deficiency, constant friction knee, shin, sach foot
L5250Hip disarticulation, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot
L5270Hip disarticulation, tilt table type; molded socket, locking hip joint, single axis constant friction knee, shin, sach foot
L5280Hemipelvectomy, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot
L5301Below knee, molded socket, shin, sach foot, endoskeletal system
L5312Knee disarticulation (or through knee), molded socket, single axis knee, pylon, sach foot, endoskeletal system
L5321Above knee, molded socket, open end, sach foot, endoskeletal system, single axis knee
L5331Hip disarticulation, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot
L5341Hemipelvectomy, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot
L5400Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment, suspension, and one cast change, below knee
L5410Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension, below knee, each additional cast change and realignment
L5420Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension and one cast change 'ak' or knee disarticulation
L5430Immediate post surgical or early fitting, application of initial rigid dressing, incl. fitting, alignment and supension, 'ak' or knee disarticulation, each additional cast change and realignment
L5450Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, below knee
L5460Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, above knee
L5500Initial, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed
L5505Initial, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed
L5510Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model
L5520Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed
L5530Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model
L5535Preparatory, below knee 'ptb' type socket, non-alignable system, no cover, sach foot, prefabricated, adjustable open end socket
L5540Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, laminated socket, molded to model
L5560Preparatory, above knee- knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model
L5570Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed
L5580Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model
L5585Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, prefabricated adjustable open end socket
L5590Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon no cover, sach foot, laminated socket, molded to model
L5595Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, thermoplastic or equal, molded to patient model
L5600Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, laminated socket, molded to patient model
L5610Addition to lower extremity, endoskeletal system, above knee, hydracadence system
L5611Addition to lower extremity, endoskeletal system, above knee - knee disarticulation, 4 bar linkage, with friction swing phase control
L5613Addition to lower extremity, endoskeletal system, above knee-knee disarticulation, 4 bar linkage, with hydraulic swing phase control
L5614Addition to lower extremity, exoskeletal system, above knee-knee disarticulation, 4 bar linkage, with pneumatic swing phase control
L5615Addition, endoskeletal knee-shin system, 4 bar linkage or multiaxial, fluid swing and stance phase control
L5616Addition to lower extremity, endoskeletal system, above knee, universal multiplex system, friction swing phase control
L5617Addition to lower extremity, quick change self-aligning unit, above knee or below knee, each
L5618Addition to lower extremity, test socket, symes
L5620Addition to lower extremity, test socket, below knee
L5622Addition to lower extremity, test socket, knee disarticulation
L5624Addition to lower extremity, test socket, above knee
L5626Addition to lower extremity, test socket, hip disarticulation
L5628Addition to lower extremity, test socket, hemipelvectomy
L5629Addition to lower extremity, below knee, acrylic socket
L5630Addition to lower extremity, symes type, expandable wall socket
L5631Addition to lower extremity, above knee or knee disarticulation, acrylic socket
L5632Addition to lower extremity, symes type, 'ptb' brim design socket
L5634Addition to lower extremity, symes type, posterior opening (canadian) socket
L5636Addition to lower extremity, symes type, medial opening socket
L5637Addition to lower extremity, below knee, total contact
L5638Addition to lower extremity, below knee, leather socket
L5639Addition to lower extremity, below knee, wood socket
L5640Addition to lower extremity, knee disarticulation, leather socket
L5642Addition to lower extremity, above knee, leather socket
L5643Addition to lower extremity, hip disarticulation, flexible inner socket, external frame
L5644Addition to lower extremity, above knee, wood socket
L5645Addition to lower extremity, below knee, flexible inner socket, external frame
L5646Addition to lower extremity, below knee, air, fluid, gel or equal, cushion socket
L5647Addition to lower extremity, below knee suction socket
L5648Addition to lower extremity, above knee, air, fluid, gel or equal, cushion socket
L5649Addition to lower extremity, ischial containment/narrow m-l socket
L5650Additions to lower extremity, total contact, above knee or knee disarticulation socket
L5651Addition to lower extremity, above knee, flexible inner socket, external frame
L5652Addition to lower extremity, suction suspension, above knee or knee disarticulation socket
L5653Addition to lower extremity, knee disarticulation, expandable wall socket
L5654Addition to lower extremity, socket insert, symes, (kemblo, pelite, aliplast, plastazote or equal)
L5655Addition to lower extremity, socket insert, below knee (kemblo, pelite, aliplast, plastazote or equal)
L5656Addition to lower extremity, socket insert, knee disarticulation (kemblo, pelite, aliplast, plastazote or equal)
L5658Addition to lower extremity, socket insert, above knee (kemblo, pelite, aliplast, plastazote or equal)
L5661Addition to lower extremity, socket insert, multi-durometer symes
L5665Addition to lower extremity, socket insert, multi-durometer, below knee
L5666Addition to lower extremity, below knee, cuff suspension
L5668Addition to lower extremity, below knee, molded distal cushion
L5670Addition to lower extremity, below knee, molded supracondylar suspension ('pts' or similar)
L5671Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert
L5672Addition to lower extremity, below knee, removable medial brim suspension
L5673Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism
L5676Additions to lower extremity, below knee, knee joints, single axis, pair
L5677Additions to lower extremity, below knee, knee joints, polycentric, pair
L5678Additions to lower extremity, below knee, joint covers, pair
L5679Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism
L5680Addition to lower extremity, below knee, thigh lacer, nonmolded
L5681Addition to lower extremity, below knee/above knee, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l5673 or l5679)
L5682Addition to lower extremity, below knee, thigh lacer, gluteal/ischial, molded
L5683Addition to lower extremity, below knee/above knee, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l5673 or l5679)
L5684Addition to lower extremity, below knee, fork strap
L5685Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each
L5686Addition to lower extremity, below knee, back check (extension control)
L5688Addition to lower extremity, below knee, waist belt, webbing
L5690Addition to lower extremity, below knee, waist belt, padded and lined
L5692Addition to lower extremity, above knee, pelvic control belt, light
L5694Addition to lower extremity, above knee, pelvic control belt, padded and lined
L5695Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each
L5696Addition to lower extremity, above knee or knee disarticulation, pelvic joint
L5697Addition to lower extremity, above knee or knee disarticulation, pelvic band
L5698Addition to lower extremity, above knee or knee disarticulation, silesian bandage
L5699All lower extremity prostheses, shoulder harness
L5700Replacement, socket, below knee, molded to patient model
L5701Replacement, socket, above knee/knee disarticulation, including attachment plate, molded to patient model
L5702Replacement, socket, hip disarticulation, including hip joint, molded to patient model
L5703Ankle, symes, molded to patient model, socket without solid ankle cushion heel (sach) foot, replacement only
L5704Custom shaped protective cover, below knee
L5705Custom shaped protective cover, above knee
L5706Custom shaped protective cover, knee disarticulation
L5707Custom shaped protective cover, hip disarticulation
L5710Addition, exoskeletal knee-shin system, single axis, manual lock
L5711Additions exoskeletal knee-shin system, single axis, manual lock, ultra-light material
L5712Addition, exoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)
L5714Addition, exoskeletal knee-shin system, single axis, variable friction swing phase control
L5716Addition, exoskeletal knee-shin system, polycentric, mechanical stance phase lock
L5718Addition, exoskeletal knee-shin system, polycentric, friction swing and stance phase control
L5722Addition, exoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control
L5724Addition, exoskeletal knee-shin system, single axis, fluid swing phase control
L5726Addition, exoskeletal knee-shin system, single axis, external joints fluid swing phase control
L5728Addition, exoskeletal knee-shin system, single axis, fluid swing and stance phase control
L5780Addition, exoskeletal knee-shin system, single axis, pneumatic/hydra pneumatic swing phase control
L5781Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system
L5782Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy duty
L5783Addition to lower extremity, user adjustable, mechanical, residual limb volume management system
L5785Addition, exoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)
L5790Addition, exoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)
L5795Addition, exoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)
L5810Addition, endoskeletal knee-shin system, single axis, manual lock
L5811Addition, endoskeletal knee-shin system, single axis, manual lock, ultra-light material
L5812Addition, endoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)
L5814Addition, endoskeletal knee-shin system, polycentric, hydraulic swing phase control, mechanical stance phase lock
L5816Addition, endoskeletal knee-shin system, polycentric, mechanical stance phase lock
L5818Addition, endoskeletal knee-shin system, polycentric, friction swing, and stance phase control
L5822Addition, endoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control
L5824Addition, endoskeletal knee-shin system, single axis, fluid swing phase control
L5826Addition, endoskeletal knee-shin system, single axis, hydraulic swing phase control, with miniature high activity frame
L5828Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control
L5830Addition, endoskeletal knee-shin system, single axis, pneumatic/ swing phase control
L5840Addition, endoskeletal knee/shin system, 4-bar linkage or multiaxial, pneumatic swing phase control
L5841Addition, endoskeletal knee-shin system, polycentric, pneumatic swing, and stance phase control
L5845Addition, endoskeletal, knee-shin system, stance flexion feature, adjustable
L5848Addition to endoskeletal knee-shin system, fluid stance extension, dampening feature, with or without adjustability
L5850Addition, endoskeletal system, above knee or hip disarticulation, knee extension assist
L5855Addition, endoskeletal system, hip disarticulation, mechanical hip extension assist
L5856Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type
L5857Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type
L5858Addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type
L5859Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s)
L5910Addition, endoskeletal system, below knee, alignable system
L5920Addition, endoskeletal system, above knee or hip disarticulation, alignable system
L5925Addition, endoskeletal system, above knee, knee disarticulation or hip disarticulation, manual lock
L5926Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type
L5930Addition, endoskeletal system, high activity knee control frame
L5940Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)
L5950Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)
L5960Addition, endoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)
L5961Addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion and/or extension control
L5962Addition, endoskeletal system, below knee, flexible protective outer surface covering system
L5964Addition, endoskeletal system, above knee, flexible protective outer surface covering system
L5966Addition, endoskeletal system, hip disarticulation, flexible protective outer surface covering system
L5968Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature
L5969Addition, endoskeletal ankle-foot or ankle system, power assist, includes any type motor(s)
L5970All lower extremity prostheses, foot, external keel, sach foot
L5971All lower extremity prosthesis, solid ankle cushion heel (sach) foot, replacement only
L5972All lower extremity prostheses, foot, flexible keel
L5973Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source
L5974All lower extremity prostheses, foot, single axis ankle/foot
L5975All lower extremity prosthesis, combination single axis ankle and flexible keel foot
L5976All lower extremity prostheses, energy storing foot (seattle carbon copy ii or equal)
L5978All lower extremity prostheses, foot, multiaxial ankle/foot
L5979All lower extremity prosthesis, multi-axial ankle, dynamic response foot, one piece system
L5980All lower extremity prostheses, flex foot system
L5981All lower extremity prostheses, flex-walk system or equal
L5982All exoskeletal lower extremity prostheses, axial rotation unit
L5984All endoskeletal lower extremity prosthesis, axial rotation unit, with or without adjustability
L5985All endoskeletal lower extremity prostheses, dynamic prosthetic pylon
L5986All lower extremity prostheses, multi-axial rotation unit ('mcp' or equal)
L5987All lower extremity prosthesis, shank foot system with vertical loading pylon
L5988Addition to lower limb prosthesis, vertical shock reducing pylon feature
L5990Addition to lower extremity prosthesis, user adjustable heel height
L5991Addition to lower extremity prostheses, osseointegrated external prosthetic connector
L5999Lower extremity prosthesis, not otherwise specified
L6000Partial hand, thumb remaining
L6010Partial hand, little and/or ring finger remaining
L6020Partial hand, no finger remaining
L6025Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectric control of terminal device
Terminated: December 31, 2014
L6026Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectric control of terminal device, excludes terminal device(s)
L6050Wrist disarticulation, molded socket, flexible elbow hinges, triceps pad
L6055Wrist disarticulation, molded socket with expandable interface, flexible elbow hinges, triceps pad
L6100Below elbow, molded socket, flexible elbow hinge, triceps pad
L6110Below elbow, molded socket, (muenster or northwestern suspension types)
L6120Below elbow, molded double wall split socket, step-up hinges, half cuff
L6130Below elbow, molded double wall split socket, stump activated locking hinge, half cuff
L6200Elbow disarticulation, molded socket, outside locking hinge, forearm
L6205Elbow disarticulation, molded socket with expandable interface, outside locking hinges, forearm
L6250Above elbow, molded double wall socket, internal locking elbow, forearm
L6300Shoulder disarticulation, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm
L6310Shoulder disarticulation, passive restoration (complete prosthesis)
L6320Shoulder disarticulation, passive restoration (shoulder cap only)
L6350Interscapular thoracic, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm
L6360Interscapular thoracic, passive restoration (complete prosthesis)
L6370Interscapular thoracic, passive restoration (shoulder cap only)
L6380Immediate post surgical or early fitting, application of initial rigid dressing, including fitting alignment and suspension of components, and one cast change, wrist disarticulation or below elbow
L6382Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, elbow disarticulation or above elbow
L6384Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, shoulder disarticulation or interscapular thoracic
L6386Immediate post surgical or early fitting, each additional cast change and realignment
L6388Immediate post surgical or early fitting, application of rigid dressing only
L6400Below elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping
L6450Elbow disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping
L6500Above elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping
L6550Shoulder disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping
L6570Interscapular thoracic, molded socket, endoskeletal system, including soft prosthetic tissue shaping
L6580Preparatory, wrist disarticulation or below elbow, single wall plastic socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden cable control, usmc or equal pylon, no cover, molded to patient model
L6582Preparatory, wrist disarticulation or below elbow, single wall socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden cable control, usmc or equal pylon, no cover, direct formed
L6584Preparatory, elbow disarticulation or above elbow, single wall plastic socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or equal pylon, no cover, molded to patient model
L6586Preparatory, elbow disarticulation or above elbow, single wall socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or equal pylon, no cover, direct formed
L6588Preparatory, shoulder disarticulation or interscapular thoracic, single wall plastic socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, usmc or equal pylon, no cover, molded to patient model
L6590Preparatory, shoulder disarticulation or interscapular thoracic, single wall socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, usmc or equal pylon, no cover, direct formed
L6600Upper extremity additions, polycentric hinge, pair
L6605Upper extremity additions, single pivot hinge, pair
L6610Upper extremity additions, flexible metal hinge, pair
L6611Addition to upper extremity prosthesis, external powered, additional switch, any type
L6615Upper extremity addition, disconnect locking wrist unit
L6616Upper extremity addition, additional disconnect insert for locking wrist unit, each
L6620Upper extremity addition, flexion/extension wrist unit, with or without friction
L6621Upper extremity prosthesis addition, flexion/extension wrist with or without friction, for use with external powered terminal device
L6623Upper extremity addition, spring assisted rotational wrist unit with latch release
L6624Upper extremity addition, flexion/extension and rotation wrist unit
L6625Upper extremity addition, rotation wrist unit with cable lock
L6628Upper extremity addition, quick disconnect hook adapter, otto bock or equal
L6629Upper extremity addition, quick disconnect lamination collar with coupling piece, otto bock or equal
L6630Upper extremity addition, stainless steel, any wrist
L6632Upper extremity addition, latex suspension sleeve, each
L6635Upper extremity addition, lift assist for elbow
L6637Upper extremity addition, nudge control elbow lock
L6638Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow
L6640Upper extremity additions, shoulder abduction joint, pair
L6641Upper extremity addition, excursion amplifier, pulley type
L6642Upper extremity addition, excursion amplifier, lever type
L6645Upper extremity addition, shoulder flexion-abduction joint, each
L6646Upper extremity addition, shoulder joint, multipositional locking, flexion, adjustable abduction friction control, for use with body powered or external powered system
L6647Upper extremity addition, shoulder lock mechanism, body powered actuator
L6648Upper extremity addition, shoulder lock mechanism, external powered actuator
L6650Upper extremity addition, shoulder universal joint, each
L6655Upper extremity addition, standard control cable, extra
L6660Upper extremity addition, heavy duty control cable
L6665Upper extremity addition, teflon, or equal, cable lining
L6670Upper extremity addition, hook to hand, cable adapter
L6672Upper extremity addition, harness, chest or shoulder, saddle type
L6675Upper extremity addition, harness, (e.g., figure of eight type), single cable design
L6676Upper extremity addition, harness, (e.g., figure of eight type), dual cable design
L6677Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow
L6680Upper extremity addition, test socket, wrist disarticulation or below elbow
L6682Upper extremity addition, test socket, elbow disarticulation or above elbow
L6684Upper extremity addition, test socket, shoulder disarticulation or interscapular thoracic
L6686Upper extremity addition, suction socket
L6687Upper extremity addition, frame type socket, below elbow or wrist disarticulation
L6688Upper extremity addition, frame type socket, above elbow or elbow disarticulation
L6689Upper extremity addition, frame type socket, shoulder disarticulation
L6690Upper extremity addition, frame type socket, interscapular-thoracic
L6691Upper extremity addition, removable insert, each
L6692Upper extremity addition, silicone gel insert or equal, each
L6693Upper extremity addition, locking elbow, forearm counterbalance
L6694Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism
L6695Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism
L6696Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695)
L6697Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695)
L6698Addition to upper extremity prosthesis, below elbow/above elbow, lock mechanism, excludes socket insert
L6703Terminal device, passive hand/mitt, any material, any size
L6704Terminal device, sport/recreational/work attachment, any material, any size
L6706Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined
L6707Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined
L6708Terminal device, hand, mechanical, voluntary opening, any material, any size
L6709Terminal device, hand, mechanical, voluntary closing, any material, any size
L6711Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined, pediatric
L6712Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined, pediatric
L6713Terminal device, hand, mechanical, voluntary opening, any material, any size, pediatric
L6714Terminal device, hand, mechanical, voluntary closing, any material, any size, pediatric
L6715Terminal device, multiple articulating digit, includes motor(s), initial issue or replacement
L6721Terminal device, hook or hand, heavy duty, mechanical, voluntary opening, any material, any size, lined or unlined
L6722Terminal device, hook or hand, heavy duty, mechanical, voluntary closing, any material, any size, lined or unlined
L6805Addition to terminal device, modifier wrist unit
L6810Addition to terminal device, precision pinch device
L6880Electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s)
L6881Automatic grasp feature, addition to upper limb electric prosthetic terminal device
L6882Microprocessor control feature, addition to upper limb prosthetic terminal device
L6883Replacement socket, below elbow/wrist disarticulation, molded to patient model, for use with or without external power
L6884Replacement socket, above elbow/elbow disarticulation, molded to patient model, for use with or without external power
L6885Replacement socket, shoulder disarticulation/interscapular thoracic, molded to patient model, for use with or without external power
L6890Addition to upper extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment
L6895Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated
L6900Hand restoration (casts, shading and measurements included), partial hand, with glove, thumb or one finger remaining
L6905Hand restoration (casts, shading and measurements included), partial hand, with glove, multiple fingers remaining
L6910Hand restoration (casts, shading and measurements included), partial hand, with glove, no fingers remaining
L6915Hand restoration (shading, and measurements included), replacement glove for above
L6920Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal, switch, cables, two batteries and one charger, switch control of terminal device
L6925Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device
L6930Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device
L6935Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device
L6940Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device
L6945Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device
L6950Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device
L6955Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device
L6960Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device
L6965Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device
L6970Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device
L6975Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device
L7007Electric hand, switch or myoelectric controlled, adult
L7008Electric hand, switch or myoelectric, controlled, pediatric
L7009Electric hook, switch or myoelectric controlled, adult
L7040Prehensile actuator, switch controlled
L7045Electric hook, switch or myoelectric controlled, pediatric
L7170Electronic elbow, hosmer or equal, switch controlled
L7180Electronic elbow, microprocessor sequential control of elbow and terminal device
L7181Electronic elbow, microprocessor simultaneous control of elbow and terminal device
L7185Electronic elbow, adolescent, variety village or equal, switch controlled
L7186Electronic elbow, child, variety village or equal, switch controlled
L7190Electronic elbow, adolescent, variety village or equal, myoelectronically controlled
L7191Electronic elbow, child, variety village or equal, myoelectronically controlled
L7259Electronic wrist rotator, any type
L7260Electronic wrist rotator, otto bock or equal
Terminated: December 31, 2014
L7261Electronic wrist rotator, for utah arm
Terminated: December 31, 2014
L7360Six volt battery, each
L7362Battery charger, six volt, each
L7364Twelve volt battery, each
L7366Battery charger, twelve volt, each
L7367Lithium ion battery, rechargeable, replacement
L7368Lithium ion battery charger, replacement only
L7400Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultralight material (titanium, carbon fiber or equal)
L7401Addition to upper extremity prosthesis, above elbow disarticulation, ultralight material (titanium, carbon fiber or equal)
L7402Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultralight material (titanium, carbon fiber or equal)
L7403Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material
L7404Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material
L7405Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material
L7499Upper extremity prosthesis, not otherwise specified
L7510Repair of prosthetic device, repair or replace minor parts
L7520Repair prosthetic device, labor component, per 15 minutes
L7600Prosthetic donning sleeve, any material, each
L7700Gasket or seal, for use with prosthetic socket insert, any type, each
L7900Male vacuum erection system
L7902Tension ring, for vacuum erection device, any type, replacement only, each
L8000Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type
L8001Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type
L8002Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type
L8010Breast prosthesis, mastectomy sleeve
L8015External breast prosthesis garment, with mastectomy form, post mastectomy
L8020Breast prosthesis, mastectomy form
L8030Breast prosthesis, silicone or equal, without integral adhesive
L8031Breast prosthesis, silicone or equal, with integral adhesive
L8032Nipple prosthesis, prefabricated, reusable, any type, each
L8033Nipple prosthesis, custom fabricated, reusable, any material, any type, each
L8035Custom breast prosthesis, post mastectomy, molded to patient model
L8039Breast prosthesis, not otherwise specified
L8040Nasal prosthesis, provided by a non-physician
L8041Midfacial prosthesis, provided by a non-physician
L8042Orbital prosthesis, provided by a non-physician
L8043Upper facial prosthesis, provided by a non-physician
L8044Hemi-facial prosthesis, provided by a non-physician
L8045Auricular prosthesis, provided by a non-physician
L8046Partial facial prosthesis, provided by a non-physician
L8047Nasal septal prosthesis, provided by a non-physician
L8048Unspecified maxillofacial prosthesis, by report, provided by a non-physician
L8049Repair or modification of maxillofacial prosthesis, labor component, 15 minute increments, provided by a non-physician
L8300Truss, single with standard pad
L8310Truss, double with standard pads
L8320Truss, addition to standard pad, water pad
L8330Truss, addition to standard pad, scrotal pad
L8400Prosthetic sheath, below knee, each
L8410Prosthetic sheath, above knee, each
L8415Prosthetic sheath, upper limb, each
L8417Prosthetic sheath/sock, including a gel cushion layer, below knee or above knee, each
L8420Prosthetic sock, multiple ply, below knee, each
L8430Prosthetic sock, multiple ply, above knee, each
L8435Prosthetic sock, multiple ply, upper limb, each
L8440Prosthetic shrinker, below knee, each
L8460Prosthetic shrinker, above knee, each
L8465Prosthetic shrinker, upper limb, each
L8470Prosthetic sock, single ply, fitting, below knee, each
L8480Prosthetic sock, single ply, fitting, above knee, each
L8485Prosthetic sock, single ply, fitting, upper limb, each
L8499Unlisted procedure for miscellaneous prosthetic services
L8500Artificial larynx, any type
L8501Tracheostomy speaking valve
L8505Artificial larynx replacement battery / accessory, any type
L8507Tracheo-esophageal voice prosthesis, patient inserted, any type, each
L8509Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type
L8510Voice amplifier
L8511Insert for indwelling tracheoesophageal prosthesis, with or without valve, replacement only, each
L8512Gelatin capsules or equivalent, for use with tracheoesophageal voice prosthesis, replacement only, per 10
L8513Cleaning device used with tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each
L8514Tracheoesophageal puncture dilator, replacement only, each
L8515Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each
L8600Implantable breast prosthesis, silicone or equal
L8603Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies
L8604Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, urinary tract, 1 ml, includes shipping and necessary supplies
L8605Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, anal canal, 1 ml, includes shipping and necessary supplies
L8606Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe, includes shipping and necessary supplies
L8607Injectable bulking agent for vocal cord medialization, 0.1 ml, includes shipping and necessary supplies
L8608Miscellaneous external component, supply or accessory for use with the argus ii retinal prosthesis system
L8609Artificial cornea
L8610Ocular implant
L8612Aqueous shunt
L8613Ossicula implant
L8614Cochlear device, includes all internal and external components
L8615Headset/headpiece for use with cochlear implant device, replacement
L8616Microphone for use with cochlear implant device, replacement
L8617Transmitting coil for use with cochlear implant device, replacement
L8618Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement
L8619Cochlear implant, external speech processor and controller, integrated system, replacement
L8621Zinc air battery for use with cochlear implant device and auditory osseointegrated sound processors, replacement, each
L8622Alkaline battery for use with cochlear implant device, any size, replacement, each
L8623Lithium ion battery for use with cochlear implant device speech processor, other than ear level, replacement, each
L8624Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement, each
L8625External recharging system for battery for use with cochlear implant or auditory osseointegrated device, replacement only, each
L8627Cochlear implant, external speech processor, component, replacement
L8628Cochlear implant, external controller component, replacement
L8629Transmitting coil and cable, integrated, for use with cochlear implant device, replacement
L8630Metacarpophalangeal joint implant
L8631Metacarpal phalangeal joint replacement, two or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon), for surgical implantation (all sizes, includes entire system)
L8641Metatarsal joint implant
L8642Hallux implant
L8658Interphalangeal joint spacer, silicone or equal, each
L8659Interphalangeal finger joint replacement, 2 or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon) for surgical implantation, any size
L8670Vascular graft material, synthetic, implant
L8678Electrical stimulator supplies (external) for use with implantable neurostimulator, per month
L8679Implantable neurostimulator, pulse generator, any type
L8680Implantable neurostimulator electrode, each
L8681Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only
L8682Implantable neurostimulator radiofrequency receiver
L8683Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver
L8684Radiofrequency transmitter (external) for use with implantable sacral root neurostimulator receiver for bowel and bladder management, replacement
L8685Implantable neurostimulator pulse generator, single array, rechargeable, includes extension
L8686Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension
L8687Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension
L8688Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension
L8689External recharging system for battery (internal) for use with implantable neurostimulator, replacement only
L8690Auditory osseointegrated device, includes all internal and external components
L8691Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each
L8692Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment
L8693Auditory osseointegrated device abutment, any length, replacement only
L8694Auditory osseointegrated device, transducer/actuator, replacement only, each
L8695External recharging system for battery (external) for use with implantable neurostimulator, replacement only
L8696Antenna (external) for use with implantable diaphragmatic/phrenic nerve stimulation device, replacement, each
L8698Miscellaneous component, supply or accessory for use with total artificial heart system
L8699Prosthetic implant, not otherwise specified
L8701Powered upper extremity range of motion assist device, elbow, wrist, hand with single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated
L8702Powered upper extremity range of motion assist device, elbow, wrist, hand, finger, single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated
L9900Orthotic and prosthetic supply, accessory, and/or service component of another hcpcs "l" code