HCPCS 'L' Codes (898)

Orthotic And Prosthetic Procedures, Devices
Code Description
L0112 Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated
L0113 Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment
L0120 Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar)
L0130 Cervical, flexible, thermoplastic collar, molded to patient
L0140 Cervical, semi-rigid, adjustable (plastic collar)
L0150 Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibular/occipital piece)
L0160 Cervical, semi-rigid, wire frame occipital/mandibular support, prefabricated, off-the-shelf
L0170 Cervical, collar, molded to patient model
L0172 Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf
L0174 Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf
L0180 Cervical, multiple post collar, occipital/mandibular supports, adjustable
L0190 Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars (somi, guilford, taylor types)
L0200 Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars, and thoracic extension
L0220 Thoracic, rib belt, custom fabricated
L0450 Tlso, 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
L0452 Tlso, 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
L0454 Tlso 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
L0455 Tlso, 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
L0456 Tlso, 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
L0457 Tlso, 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
L0458 Tlso, 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
L0460 Tlso, 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
L0462 Tlso, 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
L0464 Tlso, 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
L0466 Tlso, 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
L0467 Tlso, 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
L0468 Tlso, 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
L0469 Tlso, 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
L0470 Tlso, 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
L0472 Tlso, 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
L0480 Tlso, 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
L0482 Tlso, 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
L0484 Tlso, 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
L0486 Tlso, 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
L0488 Tlso, 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
L0490 Tlso, 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
L0491 Tlso, 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
L0492 Tlso, 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
L0621 Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf
L0622 Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated
L0623 Sacroiliac 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
L0624 Sacroiliac 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
L0625 Lumbar 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
L0626 Lumbar 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
L0627 Lumbar 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
L0628 Lumbar-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
L0629 Lumbar-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
L0630 Lumbar-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
L0631 Lumbar-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
L0632 Lumbar-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
L0633 Lumbar-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
L0634 Lumbar-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
L0635 Lumbar-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
L0636 Lumbar 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
L0637 Lumbar-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
L0638 Lumbar-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
L0639 Lumbar-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
L0640 Lumbar-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
L0641 Lumbar 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
L0642 Lumbar 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
L0643 Lumbar-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
L0648 Lumbar-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
L0649 Lumbar-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
L0650 Lumbar-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
L0651 Lumbar-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
L0700 Cervical-thoracic-lumbar-sacral-orthoses (ctlso), anterior-posterior-lateral control, molded to patient model, (minerva type)
L0710 Ctlso, anterior-posterior-lateral-control, molded to patient model, with interface material, (minerva type)
L0810 Halo procedure, cervical halo incorporated into jacket vest
L0820 Halo procedure, cervical halo incorporated into plaster body jacket
L0830 Halo procedure, cervical halo incorporated into milwaukee type orthosis
L0859 Addition to halo procedure, magnetic resonance image compatible systems, rings and pins, any material
L0861 Addition to halo procedure, replacement liner/interface material
L0970 Tlso, corset front
L0972 Lso, corset front
L0974 Tlso, full corset
L0976 Lso, full corset
L0978 Axillary crutch extension
L0980 Peroneal straps, prefabricated, off-the-shelf, pair
L0982 Stocking supporter grips, prefabricated, off-the-shelf, set of four (4)
L0984 Protective body sock, prefabricated, off-the-shelf, each
L0999 Addition to spinal orthosis, not otherwise specified
L1000 Cervical-thoracic-lumbar-sacral orthosis (ctlso) (milwaukee), inclusive of furnishing initial orthosis, including model
L1001 Cervical thoracic lumbar sacral orthosis, immobilizer, infant size, prefabricated, includes fitting and adjustment
L1005 Tension based scoliosis orthosis and accessory pads, includes fitting and adjustment
L1010 Addition to cervical-thoracic-lumbar-sacral orthosis (ctlso) or scoliosis orthosis, axilla sling
L1020 Addition to ctlso or scoliosis orthosis, kyphosis pad
L1025 Addition to ctlso or scoliosis orthosis, kyphosis pad, floating
L1030 Addition to ctlso or scoliosis orthosis, lumbar bolster pad
L1040 Addition to ctlso or scoliosis orthosis, lumbar or lumbar rib pad
L1050 Addition to ctlso or scoliosis orthosis, sternal pad
L1060 Addition to ctlso or scoliosis orthosis, thoracic pad
L1070 Addition to ctlso or scoliosis orthosis, trapezius sling
L1080 Addition to ctlso or scoliosis orthosis, outrigger
L1085 Addition to ctlso or scoliosis orthosis, outrigger, bilateral with vertical extensions
L1090 Addition to ctlso or scoliosis orthosis, lumbar sling
L1100 Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather
L1110 Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather, molded to patient model
L1120 Addition to ctlso, scoliosis orthosis, cover for upright, each
L1200 Thoracic-lumbar-sacral-orthosis (tlso), inclusive of furnishing initial orthosis only
L1210 Addition to tlso, (low profile), lateral thoracic extension
L1220 Addition to tlso, (low profile), anterior thoracic extension
L1230 Addition to tlso, (low profile), milwaukee type superstructure
L1240 Addition to tlso, (low profile), lumbar derotation pad
L1250 Addition to tlso, (low profile), anterior asis pad
L1260 Addition to tlso, (low profile), anterior thoracic derotation pad
L1270 Addition to tlso, (low profile), abdominal pad
L1280 Addition to tlso, (low profile), rib gusset (elastic), each
L1290 Addition to tlso, (low profile), lateral trochanteric pad
L1300 Other scoliosis procedure, body jacket molded to patient model
L1310 Other scoliosis procedure, post-operative body jacket
L1499 Spinal orthosis, not otherwise specified
L1600 Hip 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
L1610 Hip 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
L1620 Hip 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
L1630 Hip orthosis, abduction control of hip joints, semi-flexible (von rosen type), custom fabricated
L1640 Hip orthosis, abduction control of hip joints, static, pelvic band or spreader bar, thigh cuffs, custom fabricated
L1650 Hip orthosis, abduction control of hip joints, static, adjustable, (ilfled type), prefabricated, includes fitting and adjustment
L1652 Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, includes fitting and adjustment, any type
L1660 Hip orthosis, abduction control of hip joints, static, plastic, prefabricated, includes fitting and adjustment
L1680 Hip orthosis, abduction control of hip joints, dynamic, pelvic control, adjustable hip motion control, thigh cuffs (rancho hip action type), custom fabricated
L1685 Hip orthosis, abduction control of hip joint, postoperative hip abduction type, custom fabricated
L1686 Hip orthosis, abduction control of hip joint, postoperative hip abduction type, prefabricated, includes fitting and adjustment
L1690 Combination, bilateral, lumbo-sacral, hip, femur orthosis providing adduction and internal rotation control, prefabricated, includes fitting and adjustment
L1700 Legg perthes orthosis, (toronto type), custom fabricated
L1710 Legg perthes orthosis, (newington type), custom fabricated
L1720 Legg perthes orthosis, trilateral, (tachdijan type), custom fabricated
L1730 Legg perthes orthosis, (scottish rite type), custom fabricated
L1755 Legg perthes orthosis, (patten bottom type), custom fabricated
L1810 Knee 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
L1812 Knee orthosis, elastic with joints, prefabricated, off-the-shelf
L1820 Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, includes fitting and adjustment
L1830 Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf
L1831 Knee orthosis, locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment
L1832 Knee 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
L1833 Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf
L1834 Knee orthosis, without knee joint, rigid, custom fabricated
L1836 Knee orthosis, rigid, without joint(s), includes soft interface material, prefabricated, off-the-shelf
L1840 Knee orthosis, derotation, medial-lateral, anterior cruciate ligament, custom fabricated
L1843 Knee 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
L1844 Knee 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
L1845 Knee 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
L1846 Knee 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
L1847 Knee 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
L1848 Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated, off-the-shelf
L1850 Knee orthosis, swedish type, prefabricated, off-the-shelf
L1851 Knee 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
L1852 Knee orthosis (ko), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf
L1860 Knee orthosis, modification of supracondylar prosthetic socket, custom fabricated (sk)
L1900 Ankle foot orthosis, spring wire, dorsiflexion assist calf band, custom fabricated
L1902 Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf
L1904 Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated
L1906 Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf
L1907 Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated
L1910 Ankle foot orthosis, posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment
L1920 Ankle foot orthosis, single upright with static or adjustable stop (phelps or perlstein type), custom fabricated
L1930 Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment
L1932 Afo, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, includes fitting and adjustment
L1940 Ankle foot orthosis, plastic or other material, custom fabricated
L1945 Ankle foot orthosis, plastic, rigid anterior tibial section (floor reaction), custom fabricated
L1950 Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic, custom fabricated
L1951 Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, includes fitting and adjustment
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L1970 Ankle foot orthosis, plastic with ankle joint, custom fabricated
L1971 Ankle foot orthosis, plastic or other material with ankle joint, prefabricated, includes fitting and adjustment
L1980 Ankle foot orthosis, single upright free plantar dorsiflexion, solid stirrup, calf band/cuff (single bar 'bk' orthosis), custom fabricated
L1990 Ankle foot orthosis, double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar 'bk' orthosis), custom fabricated
L2000 Knee ankle foot orthosis, single upright, free knee, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar 'ak' orthosis), custom fabricated
L2005 Knee 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
L2010 Knee ankle foot orthosis, single upright, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar 'ak' orthosis), without knee joint, custom fabricated
L2020 Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs (double bar 'ak' orthosis), custom fabricated
L2030 Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs, (double bar 'ak' orthosis), without knee joint, custom fabricated
L2034 Knee 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
L2035 Knee ankle foot orthosis, full plastic, static (pediatric size), without free motion ankle, prefabricated, includes fitting and adjustment
L2036 Knee ankle foot orthosis, full plastic, double upright, with or without free motion knee, with or without free motion ankle, custom fabricated
L2037 Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, with or without free motion ankle, custom fabricated
L2038 Knee ankle foot orthosis, full plastic, with or without free motion knee, multi-axis ankle, custom fabricated
L2040 Hip knee ankle foot orthosis, torsion control, bilateral rotation straps, pelvic band/belt, custom fabricated
L2050 Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, hip joint, pelvic band/belt, custom fabricated
L2060 Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, ball bearing hip joint, pelvic band/ belt, custom fabricated
L2070 Hip knee ankle foot orthosis, torsion control, unilateral rotation straps, pelvic band/belt, custom fabricated
L2080 Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, hip joint, pelvic band/belt, custom fabricated
L2090 Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, ball bearing hip joint, pelvic band/ belt, custom fabricated
L2106 Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, thermoplastic type casting material, custom fabricated
L2108 Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, custom fabricated
L2112 Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment
L2114 Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment
L2116 Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, rigid, prefabricated, includes fitting and adjustment
L2126 Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, thermoplastic type casting material, custom fabricated
L2128 Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, custom fabricated
L2132 Kafo, fracture orthosis, femoral fracture cast orthosis, soft, prefabricated, includes fitting and adjustment
L2134 Kafo, fracture orthosis, femoral fracture cast orthosis, semi-rigid, prefabricated, includes fitting and adjustment
L2136 Kafo, fracture orthosis, femoral fracture cast orthosis, rigid, prefabricated, includes fitting and adjustment
L2180 Addition to lower extremity fracture orthosis, plastic shoe insert with ankle joints
L2182 Addition to lower extremity fracture orthosis, drop lock knee joint
L2184 Addition to lower extremity fracture orthosis, limited motion knee joint
L2186 Addition to lower extremity fracture orthosis, adjustable motion knee joint, lerman type
L2188 Addition to lower extremity fracture orthosis, quadrilateral brim
L2190 Addition to lower extremity fracture orthosis, waist belt
L2192 Addition to lower extremity fracture orthosis, hip joint, pelvic band, thigh flange, and pelvic belt
L2200 Addition to lower extremity, limited ankle motion, each joint
L2210 Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint
L2220 Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint
L2230 Addition to lower extremity, split flat caliper stirrups and plate attachment
L2232 Addition to lower extremity orthosis, rocker bottom for total contact ankle foot orthosis, for custom fabricated orthosis only
L2240 Addition to lower extremity, round caliper and plate attachment
L2250 Addition to lower extremity, foot plate, molded to patient model, stirrup attachment
L2260 Addition to lower extremity, reinforced solid stirrup (scott-craig type)
L2265 Addition to lower extremity, long tongue stirrup
L2270 Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad
L2275 Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2310 Addition to lower extremity, abduction bar-straight
L2320 Addition to lower extremity, non-molded lacer, for custom fabricated orthosis only
L2330 Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only
L2335 Addition to lower extremity, anterior swing band
L2340 Addition to lower extremity, pre-tibial shell, molded to patient model
L2350 Addition to lower extremity, prosthetic type, (bk) socket, molded to patient model, (used for 'ptb' 'afo' orthoses)
L2360 Addition to lower extremity, extended steel shank
L2370 Addition to lower extremity, patten bottom
L2375 Addition to lower extremity, torsion control, ankle joint and half solid stirrup
L2380 Addition to lower extremity, torsion control, straight knee joint, each joint
L2385 Addition to lower extremity, straight knee joint, heavy duty, each joint
L2387 Addition to lower extremity, polycentric knee joint, for custom fabricated knee ankle foot orthosis, each joint
L2390 Addition to lower extremity, offset knee joint, each joint
L2395 Addition to lower extremity, offset knee joint, heavy duty, each joint
L2397 Addition to lower extremity orthosis, suspension sleeve
L2405 Addition to knee joint, drop lock, each
L2415 Addition to knee lock with integrated release mechanism (bail, cable, or equal), any material, each joint
L2425 Addition to knee joint, disc or dial lock for adjustable knee flexion, each joint
L2430 Addition to knee joint, ratchet lock for active and progressive knee extension, each joint
L2492 Addition to knee joint, lift loop for drop lock ring
L2500 Addition to lower extremity, thigh/weight bearing, gluteal/ ischial weight bearing, ring
L2510 Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, molded to patient model
L2520 Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, custom fitted
L2525 Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim molded to patient model
L2526 Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim, custom fitted
L2530 Addition to lower extremity, thigh-weight bearing, lacer, non-molded
L2540 Addition to lower extremity, thigh/weight bearing, lacer, molded to patient model
L2550 Addition to lower extremity, thigh/weight bearing, high roll cuff
L2570 Addition to lower extremity, pelvic control, hip joint, clevis type two position joint, each
L2580 Addition to lower extremity, pelvic control, pelvic sling
L2600 Addition to lower extremity, pelvic control, hip joint, clevis type, or thrust bearing, free, each
L2610 Addition to lower extremity, pelvic control, hip joint, clevis or thrust bearing, lock, each
L2620 Addition to lower extremity, pelvic control, hip joint, heavy duty, each
L2622 Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each
L2624 Addition to lower extremity, pelvic control, hip joint, adjustable flexion, extension, abduction control, each
L2627 Addition to lower extremity, pelvic control, plastic, molded to patient model, reciprocating hip joint and cables
L2628 Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables
L2630 Addition to lower extremity, pelvic control, band and belt, unilateral
L2640 Addition to lower extremity, pelvic control, band and belt, bilateral
L2650 Addition to lower extremity, pelvic and thoracic control, gluteal pad, each
L2660 Addition to lower extremity, thoracic control, thoracic band
L2670 Addition to lower extremity, thoracic control, paraspinal uprights
L2680 Addition to lower extremity, thoracic control, lateral support uprights
L2750 Addition to lower extremity orthosis, plating chrome or nickel, per bar
L2755 Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only
L2760 Addition to lower extremity orthosis, extension, per extension, per bar (for lineal adjustment for growth)
L2768 Orthotic side bar disconnect device, per bar
L2780 Addition to lower extremity orthosis, non-corrosive finish, per bar
L2785 Addition to lower extremity orthosis, drop lock retainer, each
L2795 Addition to lower extremity orthosis, knee control, full kneecap
L2800 Addition to lower extremity orthosis, knee control, knee cap, medial or lateral pull, for use with custom fabricated orthosis only
L2810 Addition to lower extremity orthosis, knee control, condylar pad
L2820 Addition to lower extremity orthosis, soft interface for molded plastic, below knee section
L2830 Addition to lower extremity orthosis, soft interface for molded plastic, above knee section
L2840 Addition to lower extremity orthosis, tibial length sock, fracture or equal, each
L2850 Addition to lower extremity orthosis, femoral length sock, fracture or equal, each
L2861 Addition to lower extremity joint, knee or ankle, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each
L2999 Lower extremity orthoses, not otherwise specified
L3000 Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each
L3001 Foot, insert, removable, molded to patient model, spenco, each
L3002 Foot, insert, removable, molded to patient model, plastazote or equal, each
L3003 Foot, insert, removable, molded to patient model, silicone gel, each
L3010 Foot, insert, removable, molded to patient model, longitudinal arch support, each
L3020 Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each
L3030 Foot, insert, removable, formed to patient foot, each
L3031 Foot, insert/plate, removable, addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, each
L3040 Foot, arch support, removable, premolded, longitudinal, each
L3050 Foot, arch support, removable, premolded, metatarsal, each
L3060 Foot, arch support, removable, premolded, longitudinal/ metatarsal, each
L3070 Foot, arch support, non-removable attached to shoe, longitudinal, each
L3080 Foot, arch support, non-removable attached to shoe, metatarsal, each
L3090 Foot, arch support, non-removable attached to shoe, longitudinal/metatarsal, each
L3100 Hallus-valgus night dynamic splint, prefabricated, off-the-shelf
L3140 Foot, abduction rotation bar, including shoes
L3150 Foot, abduction rotation bar, without shoes
L3160 Foot, adjustable shoe-styled positioning device
L3170 Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each
L3201 Orthopedic shoe, oxford with supinator or pronator, infant
L3202 Orthopedic shoe, oxford with supinator or pronator, child
L3203 Orthopedic shoe, oxford with supinator or pronator, junior
L3204 Orthopedic shoe, hightop with supinator or pronator, infant
L3206 Orthopedic shoe, hightop with supinator or pronator, child
L3207 Orthopedic shoe, hightop with supinator or pronator, junior
L3208 Surgical boot, each, infant
L3209 Surgical boot, each, child
L3211 Surgical boot, each, junior
L3212 Benesch boot, pair, infant
L3213 Benesch boot, pair, child
L3214 Benesch boot, pair, junior
L3215 Orthopedic footwear, ladies shoe, oxford, each
L3216 Orthopedic footwear, ladies shoe, depth inlay, each
L3217 Orthopedic footwear, ladies shoe, hightop, depth inlay, each
L3219 Orthopedic footwear, mens shoe, oxford, each
L3221 Orthopedic footwear, mens shoe, depth inlay, each
L3222 Orthopedic footwear, mens shoe, hightop, depth inlay, each
L3224 Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthosis)
L3225 Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis)
L3230 Orthopedic footwear, custom shoe, depth inlay, each
L3250 Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each
L3251 Foot, shoe molded to patient model, silicone shoe, each
L3252 Foot, shoe molded to patient model, plastazote (or similar), custom fabricated, each
L3253 Foot, molded shoe plastazote (or similar) custom fitted, each
L3254 Non-standard size or width
L3255 Non-standard size or length
L3257 Orthopedic footwear, additional charge for split size
L3260 Surgical boot/shoe, each
L3265 Plastazote sandal, each
L3300 Lift, elevation, heel, tapered to metatarsals, per inch
L3310 Lift, elevation, heel and sole, neoprene, per inch
L3320 Lift, elevation, heel and sole, cork, per inch
L3330 Lift, elevation, metal extension (skate)
L3332 Lift, elevation, inside shoe, tapered, up to one-half inch
L3334 Lift, elevation, heel, per inch
L3340 Heel wedge, sach
L3350 Heel wedge
L3360 Sole wedge, outside sole
L3370 Sole wedge, between sole
L3380 Clubfoot wedge
L3390 Outflare wedge
L3400 Metatarsal bar wedge, rocker
L3410 Metatarsal bar wedge, between sole
L3420 Full sole and heel wedge, between sole
L3430 Heel, counter, plastic reinforced
L3440 Heel, counter, leather reinforced
L3450 Heel, sach cushion type
L3455 Heel, new leather, standard
L3460 Heel, new rubber, standard
L3465 Heel, thomas with wedge
L3470 Heel, thomas extended to ball
L3480 Heel, pad and depression for spur
L3485 Heel, pad, removable for spur
L3500 Orthopedic shoe addition, insole, leather
L3510 Orthopedic shoe addition, insole, rubber
L3520 Orthopedic shoe addition, insole, felt covered with leather
L3530 Orthopedic shoe addition, sole, half
L3540 Orthopedic shoe addition, sole, full
L3550 Orthopedic shoe addition, toe tap standard
L3560 Orthopedic shoe addition, toe tap, horseshoe
L3570 Orthopedic shoe addition, special extension to instep (leather with eyelets)
L3580 Orthopedic shoe addition, convert instep to velcro closure
L3590 Orthopedic shoe addition, convert firm shoe counter to soft counter
L3595 Orthopedic shoe addition, march bar
L3600 Transfer of an orthosis from one shoe to another, caliper plate, existing
L3610 Transfer of an orthosis from one shoe to another, caliper plate, new
L3620 Transfer of an orthosis from one shoe to another, solid stirrup, existing
L3630 Transfer of an orthosis from one shoe to another, solid stirrup, new
L3640 Transfer of an orthosis from one shoe to another, dennis browne splint (riveton), both shoes
L3649 Orthopedic shoe, modification, addition or transfer, not otherwise specified
L3650 Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf
L3660 Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf
L3670 Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf
L3671 Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3674 Shoulder orthosis, abduction positioning (airplane design), thoracic component and support bar, with or without nontorsion joint/turnbuckle, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3675 Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf
L3677 Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L3678 Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated, off-the-shelf
L3702 Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3710 Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf
L3720 Elbow orthosis, double upright with forearm/arm cuffs, free motion, custom fabricated
L3730 Elbow orthosis, double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated
L3740 Elbow orthosis, double upright with forearm/arm cuffs, adjustable position lock with active control, custom fabricated
L3760 Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L3761 Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, off-the-shelf
L3762 Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf
L3763 Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3764 Elbow wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3765 Elbow wrist hand finger orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3766 Elbow wrist hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3806 Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment
L3807 Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L3808 Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment
L3809 Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type
L3891 Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each
L3900 Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, wrist or finger driven, custom fabricated
L3901 Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom fabricated
L3904 Wrist hand finger orthosis, external powered, electric, custom fabricated
L3905 Wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3906 Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3908 Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf
L3912 Hand finger orthosis (hfo), flexion glove with elastic finger control, prefabricated, off-the-shelf
L3913 Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3915 Wrist 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
L3916 Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf
L3917 Hand 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
L3918 Hand orthosis, metacarpal fracture orthosis, prefabricated, off-the-shelf
L3919 Hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3921 Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3923 Hand 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
L3924 Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, off-the-shelf
L3925 Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf
L3927 Finger 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
L3929 Hand 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
L3930 Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, off-the-shelf
L3931 Wrist 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
L3933 Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment
L3935 Finger orthosis, nontorsion joint, may include soft interface, custom fabricated, includes fitting and adjustment
L3956 Addition of joint to upper extremity orthosis, any material; per joint
L3960 Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment
L3961 Shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3962 Shoulder elbow wrist hand orthosis, abduction positioning, erb's palsey design, prefabricated, includes fitting and adjustment
L3967 Shoulder 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
L3971 Shoulder 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
L3973 Shoulder 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
L3975 Shoulder elbow wrist hand finger orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3976 Shoulder 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
L3977 Shoulder 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
L3978 Shoulder 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
L3980 Upper extremity fracture orthosis, humeral, prefabricated, includes fitting and adjustment
L3981 Upper extremity fracture orthosis, humeral, prefabricated, includes shoulder cap design, with or without joints, forearm section, may include soft interface, straps, includes fitting and adjustments
L3982 Upper extremity fracture orthosis, radius/ulnar, prefabricated, includes fitting and adjustment
L3984 Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment
L3995 Addition to upper extremity orthosis, sock, fracture or equal, each
L3999 Upper limb orthosis, not otherwise specified
L4000 Replace girdle for spinal orthosis (ctlso or so)
L4002 Replacement strap, any orthosis, includes all components, any length, any type
L4010 Replace trilateral socket brim
L4020 Replace quadrilateral socket brim, molded to patient model
L4030 Replace quadrilateral socket brim, custom fitted
L4040 Replace molded thigh lacer, for custom fabricated orthosis only
L4045 Replace non-molded thigh lacer, for custom fabricated orthosis only
L4050 Replace molded calf lacer, for custom fabricated orthosis only
L4055 Replace non-molded calf lacer, for custom fabricated orthosis only
L4060 Replace high roll cuff
L4070 Replace proximal and distal upright for kafo
L4080 Replace metal bands kafo, proximal thigh
L4090 Replace metal bands kafo-afo, calf or distal thigh
L4100 Replace leather cuff kafo, proximal thigh
L4110 Replace leather cuff kafo-afo, calf or distal thigh
L4130 Replace pretibial shell
L4205 Repair of orthotic device, labor component, per 15 minutes
L4210 Repair of orthotic device, repair or replace minor parts
L4350 Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf
L4360 Walking 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
L4361 Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf
L4370 Pneumatic full leg splint, prefabricated, off-the-shelf
L4386 Walking 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
L4387 Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf
L4392 Replacement, soft interface material, static afo
L4394 Replace soft interface material, foot drop splint
L4396 Static 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
L4397 Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf
L4398 Foot drop splint, recumbent positioning device, prefabricated, off-the-shelf
L4631 Ankle 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
L5000 Partial foot, shoe insert with longitudinal arch, toe filler
L5010 Partial foot, molded socket, ankle height, with toe filler
L5020 Partial foot, molded socket, tibial tubercle height, with toe filler
L5050 Ankle, symes, molded socket, sach foot
L5060 Ankle, symes, metal frame, molded leather socket, articulated ankle/foot
L5100 Below knee, molded socket, shin, sach foot
L5105 Below knee, plastic socket, joints and thigh lacer, sach foot
L5150 Knee disarticulation (or through knee), molded socket, external knee joints, shin, sach foot
L5160 Knee disarticulation (or through knee), molded socket, bent knee configuration, external knee joints, shin, sach foot
L5200 Above knee, molded socket, single axis constant friction knee, shin, sach foot
L5210 Above knee, short prosthesis, no knee joint ('stubbies'), with foot blocks, no ankle joints, each
L5220 Above knee, short prosthesis, no knee joint ('stubbies'), with articulated ankle/foot, dynamically aligned, each
L5230 Above knee, for proximal femoral focal deficiency, constant friction knee, shin, sach foot
L5250 Hip disarticulation, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot
L5270 Hip disarticulation, tilt table type; molded socket, locking hip joint, single axis constant friction knee, shin, sach foot
L5280 Hemipelvectomy, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot
L5301 Below knee, molded socket, shin, sach foot, endoskeletal system
L5312 Knee disarticulation (or through knee), molded socket, single axis knee, pylon, sach foot, endoskeletal system
L5321 Above knee, molded socket, open end, sach foot, endoskeletal system, single axis knee
L5331 Hip disarticulation, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot
L5341 Hemipelvectomy, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot
L5400 Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment, suspension, and one cast change, below knee
L5410 Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension, below knee, each additional cast change and realignment
L5420 Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension and one cast change 'ak' or knee disarticulation
L5430 Immediate 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
L5450 Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, below knee
L5460 Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, above knee
L5500 Initial, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed
L5505 Initial, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed
L5510 Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model
L5520 Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed
L5530 Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model
L5535 Preparatory, below knee 'ptb' type socket, non-alignable system, no cover, sach foot, prefabricated, adjustable open end socket
L5540 Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, laminated socket, molded to model
L5560 Preparatory, above knee- knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model
L5570 Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed
L5580 Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model
L5585 Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, prefabricated adjustable open end socket
L5590 Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon no cover, sach foot, laminated socket, molded to model
L5595 Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, thermoplastic or equal, molded to patient model
L5600 Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, laminated socket, molded to patient model
L5610 Addition to lower extremity, endoskeletal system, above knee, hydracadence system
L5611 Addition to lower extremity, endoskeletal system, above knee - knee disarticulation, 4 bar linkage, with friction swing phase control
L5613 Addition to lower extremity, endoskeletal system, above knee-knee disarticulation, 4 bar linkage, with hydraulic swing phase control
L5614 Addition to lower extremity, exoskeletal system, above knee-knee disarticulation, 4 bar linkage, with pneumatic swing phase control
L5616 Addition to lower extremity, endoskeletal system, above knee, universal multiplex system, friction swing phase control
L5617 Addition to lower extremity, quick change self-aligning unit, above knee or below knee, each
L5618 Addition to lower extremity, test socket, symes
L5620 Addition to lower extremity, test socket, below knee
L5622 Addition to lower extremity, test socket, knee disarticulation
L5624 Addition to lower extremity, test socket, above knee
L5626 Addition to lower extremity, test socket, hip disarticulation
L5628 Addition to lower extremity, test socket, hemipelvectomy
L5629 Addition to lower extremity, below knee, acrylic socket
L5630 Addition to lower extremity, symes type, expandable wall socket
L5631 Addition to lower extremity, above knee or knee disarticulation, acrylic socket
L5632 Addition to lower extremity, symes type, 'ptb' brim design socket
L5634 Addition to lower extremity, symes type, posterior opening (canadian) socket
L5636 Addition to lower extremity, symes type, medial opening socket
L5637 Addition to lower extremity, below knee, total contact
L5638 Addition to lower extremity, below knee, leather socket
L5639 Addition to lower extremity, below knee, wood socket
L5640 Addition to lower extremity, knee disarticulation, leather socket
L5642 Addition to lower extremity, above knee, leather socket
L5643 Addition to lower extremity, hip disarticulation, flexible inner socket, external frame
L5644 Addition to lower extremity, above knee, wood socket
L5645 Addition to lower extremity, below knee, flexible inner socket, external frame
L5646 Addition to lower extremity, below knee, air, fluid, gel or equal, cushion socket
L5647 Addition to lower extremity, below knee suction socket
L5648 Addition to lower extremity, above knee, air, fluid, gel or equal, cushion socket
L5649 Addition to lower extremity, ischial containment/narrow m-l socket
L5650 Additions to lower extremity, total contact, above knee or knee disarticulation socket
L5651 Addition to lower extremity, above knee, flexible inner socket, external frame
L5652 Addition to lower extremity, suction suspension, above knee or knee disarticulation socket
L5653 Addition to lower extremity, knee disarticulation, expandable wall socket
L5654 Addition to lower extremity, socket insert, symes, (kemblo, pelite, aliplast, plastazote or equal)
L5655 Addition to lower extremity, socket insert, below knee (kemblo, pelite, aliplast, plastazote or equal)
L5656 Addition to lower extremity, socket insert, knee disarticulation (kemblo, pelite, aliplast, plastazote or equal)
L5658 Addition to lower extremity, socket insert, above knee (kemblo, pelite, aliplast, plastazote or equal)
L5661 Addition to lower extremity, socket insert, multi-durometer symes
L5665 Addition to lower extremity, socket insert, multi-durometer, below knee
L5666 Addition to lower extremity, below knee, cuff suspension
L5668 Addition to lower extremity, below knee, molded distal cushion
L5670 Addition to lower extremity, below knee, molded supracondylar suspension ('pts' or similar)
L5671 Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert
L5672 Addition to lower extremity, below knee, removable medial brim suspension
L5673 Addition 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
L5676 Additions to lower extremity, below knee, knee joints, single axis, pair
L5677 Additions to lower extremity, below knee, knee joints, polycentric, pair
L5678 Additions to lower extremity, below knee, joint covers, pair
L5679 Addition 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
L5680 Addition to lower extremity, below knee, thigh lacer, nonmolded
L5681 Addition 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)
L5682 Addition to lower extremity, below knee, thigh lacer, gluteal/ischial, molded
L5683 Addition 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)
L5684 Addition to lower extremity, below knee, fork strap
L5685 Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each
L5686 Addition to lower extremity, below knee, back check (extension control)
L5688 Addition to lower extremity, below knee, waist belt, webbing
L5690 Addition to lower extremity, below knee, waist belt, padded and lined
L5692 Addition to lower extremity, above knee, pelvic control belt, light
L5694 Addition to lower extremity, above knee, pelvic control belt, padded and lined
L5695 Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each
L5696 Addition to lower extremity, above knee or knee disarticulation, pelvic joint
L5697 Addition to lower extremity, above knee or knee disarticulation, pelvic band
L5698 Addition to lower extremity, above knee or knee disarticulation, silesian bandage
L5699 All lower extremity prostheses, shoulder harness
L5700 Replacement, socket, below knee, molded to patient model
L5701 Replacement, socket, above knee/knee disarticulation, including attachment plate, molded to patient model
L5702 Replacement, socket, hip disarticulation, including hip joint, molded to patient model
L5703 Ankle, symes, molded to patient model, socket without solid ankle cushion heel (sach) foot, replacement only
L5704 Custom shaped protective cover, below knee
L5705 Custom shaped protective cover, above knee
L5706 Custom shaped protective cover, knee disarticulation
L5707 Custom shaped protective cover, hip disarticulation
L5710 Addition, exoskeletal knee-shin system, single axis, manual lock
L5711 Additions exoskeletal knee-shin system, single axis, manual lock, ultra-light material
L5712 Addition, exoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)
L5714 Addition, exoskeletal knee-shin system, single axis, variable friction swing phase control
L5716 Addition, exoskeletal knee-shin system, polycentric, mechanical stance phase lock
L5718 Addition, exoskeletal knee-shin system, polycentric, friction swing and stance phase control
L5722 Addition, exoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control
L5724 Addition, exoskeletal knee-shin system, single axis, fluid swing phase control
L5726 Addition, exoskeletal knee-shin system, single axis, external joints fluid swing phase control
L5728 Addition, exoskeletal knee-shin system, single axis, fluid swing and stance phase control
L5780 Addition, exoskeletal knee-shin system, single axis, pneumatic/hydra pneumatic swing phase control
L5781 Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system
L5782 Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy duty
L5785 Addition, exoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)
L5790 Addition, exoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)
L5795 Addition, exoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)
L5810 Addition, endoskeletal knee-shin system, single axis, manual lock
L5811 Addition, endoskeletal knee-shin system, single axis, manual lock, ultra-light material
L5812 Addition, endoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)
L5814 Addition, endoskeletal knee-shin system, polycentric, hydraulic swing phase control, mechanical stance phase lock
L5816 Addition, endoskeletal knee-shin system, polycentric, mechanical stance phase lock
L5818 Addition, endoskeletal knee-shin system, polycentric, friction swing, and stance phase control
L5822 Addition, endoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control
L5824 Addition, endoskeletal knee-shin system, single axis, fluid swing phase control
L5826 Addition, endoskeletal knee-shin system, single axis, hydraulic swing phase control, with miniature high activity frame
L5828 Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control
L5830 Addition, endoskeletal knee-shin system, single axis, pneumatic/ swing phase control
L5840 Addition, endoskeletal knee/shin system, 4-bar linkage or multiaxial, pneumatic swing phase control
L5845 Addition, endoskeletal, knee-shin system, stance flexion feature, adjustable
L5848 Addition to endoskeletal knee-shin system, fluid stance extension, dampening feature, with or without adjustability
L5850 Addition, endoskeletal system, above knee or hip disarticulation, knee extension assist
L5855 Addition, endoskeletal system, hip disarticulation, mechanical hip extension assist
L5856 Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type
L5857 Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type
L5858 Addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type
L5859 Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s)
L5910 Addition, endoskeletal system, below knee, alignable system
L5920 Addition, endoskeletal system, above knee or hip disarticulation, alignable system
L5925 Addition, endoskeletal system, above knee, knee disarticulation or hip disarticulation, manual lock
L5930 Addition, endoskeletal system, high activity knee control frame
L5940 Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)
L5950 Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)
L5960 Addition, endoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)
L5961 Addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion and/or extension control
L5962 Addition, endoskeletal system, below knee, flexible protective outer surface covering system
L5964 Addition, endoskeletal system, above knee, flexible protective outer surface covering system
L5966 Addition, endoskeletal system, hip disarticulation, flexible protective outer surface covering system
L5968 Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature
L5969 Addition, endoskeletal ankle-foot or ankle system, power assist, includes any type motor(s)
L5970 All lower extremity prostheses, foot, external keel, sach foot
L5971 All lower extremity prosthesis, solid ankle cushion heel (sach) foot, replacement only
L5972 All lower extremity prostheses, foot, flexible keel
L5973 Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source
L5974 All lower extremity prostheses, foot, single axis ankle/foot
L5975 All lower extremity prosthesis, combination single axis ankle and flexible keel foot
L5976 All lower extremity prostheses, energy storing foot (seattle carbon copy ii or equal)
L5978 All lower extremity prostheses, foot, multiaxial ankle/foot
L5979 All lower extremity prosthesis, multi-axial ankle, dynamic response foot, one piece system
L5980 All lower extremity prostheses, flex foot system
L5981 All lower extremity prostheses, flex-walk system or equal
L5982 All exoskeletal lower extremity prostheses, axial rotation unit
L5984 All endoskeletal lower extremity prosthesis, axial rotation unit, with or without adjustability
L5985 All endoskeletal lower extremity prostheses, dynamic prosthetic pylon
L5986 All lower extremity prostheses, multi-axial rotation unit ('mcp' or equal)
L5987 All lower extremity prosthesis, shank foot system with vertical loading pylon
L5988 Addition to lower limb prosthesis, vertical shock reducing pylon feature
L5990 Addition to lower extremity prosthesis, user adjustable heel height
L5999 Lower extremity prosthesis, not otherwise specified
L6000 Partial hand, thumb remaining
L6010 Partial hand, little and/or ring finger remaining
L6020 Partial hand, no finger remaining
L6025 Transcarpal/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.
L6026 Transcarpal/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)
L6050 Wrist disarticulation, molded socket, flexible elbow hinges, triceps pad
L6055 Wrist disarticulation, molded socket with expandable interface, flexible elbow hinges, triceps pad
L6100 Below elbow, molded socket, flexible elbow hinge, triceps pad
L6110 Below elbow, molded socket, (muenster or northwestern suspension types)
L6120 Below elbow, molded double wall split socket, step-up hinges, half cuff
L6130 Below elbow, molded double wall split socket, stump activated locking hinge, half cuff
L6200 Elbow disarticulation, molded socket, outside locking hinge, forearm
L6205 Elbow disarticulation, molded socket with expandable interface, outside locking hinges, forearm
L6250 Above elbow, molded double wall socket, internal locking elbow, forearm
L6300 Shoulder disarticulation, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm
L6310 Shoulder disarticulation, passive restoration (complete prosthesis)
L6320 Shoulder disarticulation, passive restoration (shoulder cap only)
L6350 Interscapular thoracic, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm
L6360 Interscapular thoracic, passive restoration (complete prosthesis)
L6370 Interscapular thoracic, passive restoration (shoulder cap only)
L6380 Immediate 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
L6382 Immediate 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
L6384 Immediate 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
L6386 Immediate post surgical or early fitting, each additional cast change and realignment
L6388 Immediate post surgical or early fitting, application of rigid dressing only
L6400 Below elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping
L6450 Elbow disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping
L6500 Above elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping
L6550 Shoulder disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping
L6570 Interscapular thoracic, molded socket, endoskeletal system, including soft prosthetic tissue shaping
L6580 Preparatory, 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
L6582 Preparatory, 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
L6584 Preparatory, 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
L6586 Preparatory, 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
L6588 Preparatory, 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
L6590 Preparatory, 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
L6600 Upper extremity additions, polycentric hinge, pair
L6605 Upper extremity additions, single pivot hinge, pair
L6610 Upper extremity additions, flexible metal hinge, pair
L6611 Addition to upper extremity prosthesis, external powered, additional switch, any type
L6615 Upper extremity addition, disconnect locking wrist unit
L6616 Upper extremity addition, additional disconnect insert for locking wrist unit, each
L6620 Upper extremity addition, flexion/extension wrist unit, with or without friction
L6621 Upper extremity prosthesis addition, flexion/extension wrist with or without friction, for use with external powered terminal device
L6623 Upper extremity addition, spring assisted rotational wrist unit with latch release
L6624 Upper extremity addition, flexion/extension and rotation wrist unit
L6625 Upper extremity addition, rotation wrist unit with cable lock
L6628 Upper extremity addition, quick disconnect hook adapter, otto bock or equal
L6629 Upper extremity addition, quick disconnect lamination collar with coupling piece, otto bock or equal
L6630 Upper extremity addition, stainless steel, any wrist
L6632 Upper extremity addition, latex suspension sleeve, each
L6635 Upper extremity addition, lift assist for elbow
L6637 Upper extremity addition, nudge control elbow lock
L6638 Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow
L6640 Upper extremity additions, shoulder abduction joint, pair
L6641 Upper extremity addition, excursion amplifier, pulley type
L6642 Upper extremity addition, excursion amplifier, lever type
L6645 Upper extremity addition, shoulder flexion-abduction joint, each
L6646 Upper extremity addition, shoulder joint, multipositional locking, flexion, adjustable abduction friction control, for use with body powered or external powered system
L6647 Upper extremity addition, shoulder lock mechanism, body powered actuator
L6648 Upper extremity addition, shoulder lock mechanism, external powered actuator
L6650 Upper extremity addition, shoulder universal joint, each
L6655 Upper extremity addition, standard control cable, extra
L6660 Upper extremity addition, heavy duty control cable
L6665 Upper extremity addition, teflon, or equal, cable lining
L6670 Upper extremity addition, hook to hand, cable adapter
L6672 Upper extremity addition, harness, chest or shoulder, saddle type
L6675 Upper extremity addition, harness, (e.g., figure of eight type), single cable design
L6676 Upper extremity addition, harness, (e.g., figure of eight type), dual cable design
L6677 Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow
L6680 Upper extremity addition, test socket, wrist disarticulation or below elbow
L6682 Upper extremity addition, test socket, elbow disarticulation or above elbow
L6684 Upper extremity addition, test socket, shoulder disarticulation or interscapular thoracic
L6686 Upper extremity addition, suction socket
L6687 Upper extremity addition, frame type socket, below elbow or wrist disarticulation
L6688 Upper extremity addition, frame type socket, above elbow or elbow disarticulation
L6689 Upper extremity addition, frame type socket, shoulder disarticulation
L6690 Upper extremity addition, frame type socket, interscapular-thoracic
L6691 Upper extremity addition, removable insert, each
L6692 Upper extremity addition, silicone gel insert or equal, each
L6693 Upper extremity addition, locking elbow, forearm counterbalance
L6694 Addition 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
L6695 Addition 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
L6696 Addition 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)
L6697 Addition 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)
L6698 Addition to upper extremity prosthesis, below elbow/above elbow, lock mechanism, excludes socket insert
L6703 Terminal device, passive hand/mitt, any material, any size
L6704 Terminal device, sport/recreational/work attachment, any material, any size
L6706 Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined
L6707 Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined
L6708 Terminal device, hand, mechanical, voluntary opening, any material, any size
L6709 Terminal device, hand, mechanical, voluntary closing, any material, any size
L6711 Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined, pediatric
L6712 Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined, pediatric
L6713 Terminal device, hand, mechanical, voluntary opening, any material, any size, pediatric
L6714 Terminal device, hand, mechanical, voluntary closing, any material, any size, pediatric
L6715 Terminal device, multiple articulating digit, includes motor(s), initial issue or replacement
L6721 Terminal device, hook or hand, heavy duty, mechanical, voluntary opening, any material, any size, lined or unlined
L6722 Terminal device, hook or hand, heavy duty, mechanical, voluntary closing, any material, any size, lined or unlined
L6805 Addition to terminal device, modifier wrist unit
L6810 Addition to terminal device, precision pinch device
L6880 Electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s)
L6881 Automatic grasp feature, addition to upper limb electric prosthetic terminal device
L6882 Microprocessor control feature, addition to upper limb prosthetic terminal device
L6883 Replacement socket, below elbow/wrist disarticulation, molded to patient model, for use with or without external power
L6884 Replacement socket, above elbow/elbow disarticulation, molded to patient model, for use with or without external power
L6885 Replacement socket, shoulder disarticulation/interscapular thoracic, molded to patient model, for use with or without external power
L6890 Addition to upper extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment
L6895 Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated
L6900 Hand restoration (casts, shading and measurements included), partial hand, with glove, thumb or one finger remaining
L6905 Hand restoration (casts, shading and measurements included), partial hand, with glove, multiple fingers remaining
L6910 Hand restoration (casts, shading and measurements included), partial hand, with glove, no fingers remaining
L6915 Hand restoration (shading, and measurements included), replacement glove for above
L6920 Wrist 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
L6925 Wrist 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
L6930 Below 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
L6935 Below 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
L6940 Elbow 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
L6945 Elbow 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
L6950 Above 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
L6955 Above 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
L6960 Shoulder 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
L6965 Shoulder 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
L6970 Interscapular-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
L6975 Interscapular-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
L7007 Electric hand, switch or myoelectric controlled, adult
L7008 Electric hand, switch or myoelectric, controlled, pediatric
L7009 Electric hook, switch or myoelectric controlled, adult
L7040 Prehensile actuator, switch controlled
L7045 Electric hook, switch or myoelectric controlled, pediatric
L7170 Electronic elbow, hosmer or equal, switch controlled
L7180 Electronic elbow, microprocessor sequential control of elbow and terminal device
L7181 Electronic elbow, microprocessor simultaneous control of elbow and terminal device
L7185 Electronic elbow, adolescent, variety village or equal, switch controlled
L7186 Electronic elbow, child, variety village or equal, switch controlled
L7190 Electronic elbow, adolescent, variety village or equal, myoelectronically controlled
L7191 Electronic elbow, child, variety village or equal, myoelectronically controlled
L7259 Electronic wrist rotator, any type
L7260 Electronic wrist rotator, otto bock or equal
Terminated December 31, 2014.
L7261 Electronic wrist rotator, for utah arm
Terminated December 31, 2014.
L7360 Six volt battery, each
L7362 Battery charger, six volt, each
L7364 Twelve volt battery, each
L7366 Battery charger, twelve volt, each
L7367 Lithium ion battery, rechargeable, replacement
L7368 Lithium ion battery charger, replacement only
L7400 Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultralight material (titanium, carbon fiber or equal)
L7401 Addition to upper extremity prosthesis, above elbow disarticulation, ultralight material (titanium, carbon fiber or equal)
L7402 Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultralight material (titanium, carbon fiber or equal)
L7403 Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material
L7404 Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material
L7405 Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material
L7499 Upper extremity prosthesis, not otherwise specified
L7510 Repair of prosthetic device, repair or replace minor parts
L7520 Repair prosthetic device, labor component, per 15 minutes
L7600 Prosthetic donning sleeve, any material, each
L7700 Gasket or seal, for use with prosthetic socket insert, any type, each
L7900 Male vacuum erection system
L7902 Tension ring, for vacuum erection device, any type, replacement only, each
L8000 Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type
L8001 Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type
L8002 Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type
L8010 Breast prosthesis, mastectomy sleeve
L8015 External breast prosthesis garment, with mastectomy form, post mastectomy
L8020 Breast prosthesis, mastectomy form
L8030 Breast prosthesis, silicone or equal, without integral adhesive
L8031 Breast prosthesis, silicone or equal, with integral adhesive
L8032 Nipple prosthesis, reusable, any type, each
L8035 Custom breast prosthesis, post mastectomy, molded to patient model
L8039 Breast prosthesis, not otherwise specified
L8040 Nasal prosthesis, provided by a non-physician
L8041 Midfacial prosthesis, provided by a non-physician
L8042 Orbital prosthesis, provided by a non-physician
L8043 Upper facial prosthesis, provided by a non-physician
L8044 Hemi-facial prosthesis, provided by a non-physician
L8045 Auricular prosthesis, provided by a non-physician
L8046 Partial facial prosthesis, provided by a non-physician
L8047 Nasal septal prosthesis, provided by a non-physician
L8048 Unspecified maxillofacial prosthesis, by report, provided by a non-physician
L8049 Repair or modification of maxillofacial prosthesis, labor component, 15 minute increments, provided by a non-physician
L8300 Truss, single with standard pad
L8310 Truss, double with standard pads
L8320 Truss, addition to standard pad, water pad
L8330 Truss, addition to standard pad, scrotal pad
L8400 Prosthetic sheath, below knee, each
L8410 Prosthetic sheath, above knee, each
L8415 Prosthetic sheath, upper limb, each
L8417 Prosthetic sheath/sock, including a gel cushion layer, below knee or above knee, each
L8420 Prosthetic sock, multiple ply, below knee, each
L8430 Prosthetic sock, multiple ply, above knee, each
L8435 Prosthetic sock, multiple ply, upper limb, each
L8440 Prosthetic shrinker, below knee, each
L8460 Prosthetic shrinker, above knee, each
L8465 Prosthetic shrinker, upper limb, each
L8470 Prosthetic sock, single ply, fitting, below knee, each
L8480 Prosthetic sock, single ply, fitting, above knee, each
L8485 Prosthetic sock, single ply, fitting, upper limb, each
L8499 Unlisted procedure for miscellaneous prosthetic services
L8500 Artificial larynx, any type
L8501 Tracheostomy speaking valve
L8505 Artificial larynx replacement battery / accessory, any type
L8507 Tracheo-esophageal voice prosthesis, patient inserted, any type, each
L8509 Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type
L8510 Voice amplifier
L8511 Insert for indwelling tracheoesophageal prosthesis, with or without valve, replacement only, each
L8512 Gelatin capsules or equivalent, for use with tracheoesophageal voice prosthesis, replacement only, per 10
L8513 Cleaning device used with tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each
L8514 Tracheoesophageal puncture dilator, replacement only, each
L8515 Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each
L8600 Implantable breast prosthesis, silicone or equal
L8603 Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies
L8604 Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, urinary tract, 1 ml, includes shipping and necessary supplies
L8605 Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, anal canal, 1 ml, includes shipping and necessary supplies
L8606 Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe, includes shipping and necessary supplies
L8607 Injectable bulking agent for vocal cord medialization, 0.1 ml, includes shipping and necessary supplies
L8609 Artificial cornea
L8610 Ocular implant
L8612 Aqueous shunt
L8613 Ossicula implant
L8614 Cochlear device, includes all internal and external components
L8615 Headset/headpiece for use with cochlear implant device, replacement
L8616 Microphone for use with cochlear implant device, replacement
L8617 Transmitting coil for use with cochlear implant device, replacement
L8618 Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement
L8619 Cochlear implant, external speech processor and controller, integrated system, replacement
L8621 Zinc air battery for use with cochlear implant device and auditory osseointegrated sound processors, replacement, each
L8622 Alkaline battery for use with cochlear implant device, any size, replacement, each
L8623 Lithium ion battery for use with cochlear implant device speech processor, other than ear level, replacement, each
L8624 Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement, each
L8625 External recharging system for battery for use with cochlear implant or auditory osseointegrated device, replacement only, each
L8627 Cochlear implant, external speech processor, component, replacement
L8628 Cochlear implant, external controller component, replacement
L8629 Transmitting coil and cable, integrated, for use with cochlear implant device, replacement
L8630 Metacarpophalangeal joint implant
L8631 Metacarpal 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)
L8641 Metatarsal joint implant
L8642 Hallux implant
L8658 Interphalangeal joint spacer, silicone or equal, each
L8659 Interphalangeal 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
L8670 Vascular graft material, synthetic, implant
L8679 Implantable neurostimulator, pulse generator, any type
L8680 Implantable neurostimulator electrode, each
L8681 Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only
L8682 Implantable neurostimulator radiofrequency receiver
L8683 Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver
L8684 Radiofrequency transmitter (external) for use with implantable sacral root neurostimulator receiver for bowel and bladder management, replacement
L8685 Implantable neurostimulator pulse generator, single array, rechargeable, includes extension
L8686 Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension
L8687 Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension
L8688 Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension
L8689 External recharging system for battery (internal) for use with implantable neurostimulator, replacement only
L8690 Auditory osseointegrated device, includes all internal and external components
L8691 Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each
L8692 Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment
L8693 Auditory osseointegrated device abutment, any length, replacement only
L8694 Auditory osseointegrated device, transducer/actuator, replacement only, each
L8695 External recharging system for battery (external) for use with implantable neurostimulator, replacement only
L8696 Antenna (external) for use with implantable diaphragmatic/phrenic nerve stimulation device, replacement, each
L8699 Prosthetic implant, not otherwise specified
L9900 Orthotic and prosthetic supply, accessory, and/or service component of another hcpcs "l" code