L Codes

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

L0430

Spinal orthosis, anterior-posterior-lateral control, with interface material, custom fitted (dewall posture protector only)

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, with adjustable position locking joint(s), prefabricated, includes fitting and adjustments, any type

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

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

L7261

Electronic wrist rotator, for utah arm

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

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, 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 device speech processor, ear level, replacement, 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, replacement

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

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

 

 

© BestRx Pharmacy Software