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