| L3000 |
Ft insert ucb berkeley shell |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
| L3001 |
Foot insert remov molded spe |
Foot, insert, removable, molded to patient model, spenco, each |
| L3002 |
Foot insert plastazote or eq |
Foot, insert, removable, molded to patient model, plastazote or equal, each |
| L3003 |
Foot insert silicone gel eac |
Foot, insert, removable, molded to patient model, silicone gel, each |
| L3010 |
Foot longitudinal arch suppo |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
| L3020 |
Foot longitud/metatarsal sup |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
| L3030 |
Foot arch support remov prem |
Foot, insert, removable, formed to patient foot, each |
| L3031 |
Foot lamin/prepreg composite |
Foot, insert/plate, removable, addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, each |
| L3040 |
Ft arch suprt premold longit |
Foot, arch support, removable, premolded, longitudinal, each |
| L3050 |
Foot arch supp premold metat |
Foot, arch support, removable, premolded, metatarsal, each |
| L3060 |
Foot arch supp longitud/meta |
Foot, arch support, removable, premolded, longitudinal/ metatarsal, each |
| L3070 |
Arch suprt att to sho longit |
Foot, arch support, non-removable attached to shoe, longitudinal, each |
| L3080 |
Arch supp att to shoe metata |
Foot, arch support, non-removable attached to shoe, metatarsal, each |
| L3090 |
Arch supp att to shoe long/m |
Foot, arch support, non-removable attached to shoe, longitudinal/metatarsal, each |
| L3100 |
Hallus-valgus nt dyn pre ots |
Hallus-valgus night dynamic splint, prefabricated, off-the-shelf |
| L3140 |
Abduction rotation bar shoe |
Foot, abduction rotation bar, including shoes |
| L3150 |
Abduct rotation bar w/o shoe |
Foot, abduction rotation bar, without shoes |
| L3160 |
Shoe styled positioning dev |
Foot, adjustable shoe-styled positioning device |
| L3161 |
Foot, adductus position, adj |
Foot, adductus positioning device, adjustable |
| L3170 |
Foot plas heel stabi pre ots |
Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each |
| L3201 |
Oxford w supinat/pronat inf |
Orthopedic shoe, oxford with supinator or pronator, infant |
| L3202 |
Oxford w/ supinat/pronator c |
Orthopedic shoe, oxford with supinator or pronator, child |
| L3203 |
Oxford w/ supinator/pronator |
Orthopedic shoe, oxford with supinator or pronator, junior |
| L3204 |
Hightop w/ supp/pronator inf |
Orthopedic shoe, hightop with supinator or pronator, infant |
| L3206 |
Hightop w/ supp/pronator chi |
Orthopedic shoe, hightop with supinator or pronator, child |
| L3207 |
Hightop w/ supp/pronator jun |
Orthopedic shoe, hightop with supinator or pronator, junior |
| L3208 |
Surgical boot each infant |
Surgical boot, each, infant |
| L3209 |
Surgical boot each child |
Surgical boot, each, child |
| L3211 |
Surgical boot each junior |
Surgical boot, each, junior |
| L3212 |
Benesch boot pair infant |
Benesch boot, pair, infant |
| L3213 |
Benesch boot pair child |
Benesch boot, pair, child |
| L3214 |
Benesch boot pair junior |
Benesch boot, pair, junior |
| L3215 |
Orthopedic ftwear ladies oxf |
Orthopedic footwear, ladies shoe, oxford, each |
| L3216 |
Orthoped ladies shoes dpth i |
Orthopedic footwear, ladies shoe, depth inlay, each |
| L3217 |
Ladies shoes hightop depth i |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
| L3219 |
Orthopedic mens shoes oxford |
Orthopedic footwear, mens shoe, oxford, each |
| L3221 |
Orthopedic mens shoes dpth i |
Orthopedic footwear, mens shoe, depth inlay, each |
| L3222 |
Mens shoes hightop depth inl |
Orthopedic footwear, mens shoe, hightop, depth inlay, each |
| L3224 |
Woman's shoe oxford brace |
Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthosis) |
| L3225 |
Man's shoe oxford brace |
Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis) |
| L3230 |
Custom shoes depth inlay |
Orthopedic footwear, custom shoe, depth inlay, each |
| L3250 |
Custom mold shoe remov prost |
Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each |
| L3251 |
Shoe molded to pt silicone s |
Foot, shoe molded to patient model, silicone shoe, each |
| L3252 |
Shoe molded plastazote cust |
Foot, shoe molded to patient model, plastazote (or similar), custom fabricated, each |
| L3253 |
Shoe molded plastazote cust |
Foot, molded shoe plastazote (or similar) custom fitted, each |
| L3254 |
Orth foot non-stndard size/w |
Non-standard size or width |
| L3255 |
Orth foot non-standard size/ |
Non-standard size or length |
| L3257 |
Orth foot add charge split s |
Orthopedic footwear, additional charge for split size |
| L3260 |
Ambulatory surgical boot eac |
Surgical boot/shoe, each |
| L3265 |
Plastazote sandal each |
Plastazote sandal, each |
| L3300 |
Sho lift taper to metatarsal |
Lift, elevation, heel, tapered to metatarsals, per inch |
| L3310 |
Shoe lift elev heel/sole neo |
Lift, elevation, heel and sole, neoprene, per inch |
| L3320 |
Shoe lift elev heel/sole cor |
Lift, elevation, heel and sole, cork, per inch |
| L3330 |
Lifts elevation metal extens |
Lift, elevation, metal extension (skate) |
| L3332 |
Shoe lifts tapered to one-ha |
Lift, elevation, inside shoe, tapered, up to one-half inch |
| L3334 |
Shoe lifts elevation heel /i |
Lift, elevation, heel, per inch |
| L3340 |
Shoe wedge sach |
Heel wedge, sach |
| L3350 |
Shoe heel wedge |
Heel wedge |
| L3360 |
Shoe sole wedge outside sole |
Sole wedge, outside sole |
| L3370 |
Shoe sole wedge between sole |
Sole wedge, between sole |
| L3380 |
Shoe clubfoot wedge |
Clubfoot wedge |
| L3390 |
Shoe outflare wedge |
Outflare wedge |
| L3400 |
Shoe metatarsal bar wedge ro |
Metatarsal bar wedge, rocker |
| L3410 |
Shoe metatarsal bar between |
Metatarsal bar wedge, between sole |
| L3420 |
Full sole/heel wedge btween |
Full sole and heel wedge, between sole |
| L3430 |
Sho heel count plast reinfor |
Heel, counter, plastic reinforced |
| L3440 |
Heel leather reinforced |
Heel, counter, leather reinforced |
| L3450 |
Shoe heel sach cushion type |
Heel, sach cushion type |
| L3455 |
Shoe heel new leather standa |
Heel, new leather, standard |
| L3460 |
Shoe heel new rubber standar |
Heel, new rubber, standard |
| L3465 |
Shoe heel thomas with wedge |
Heel, thomas with wedge |
| L3470 |
Shoe heel thomas extend to b |
Heel, thomas extended to ball |
| L3480 |
Shoe heel pad & depress for |
Heel, pad and depression for spur |
| L3485 |
Shoe heel pad removable for |
Heel, pad, removable for spur |
| L3500 |
Ortho shoe add leather insol |
Orthopedic shoe addition, insole, leather |
| L3510 |
Orthopedic shoe add rub insl |
Orthopedic shoe addition, insole, rubber |
| L3520 |
O shoe add felt w leath insl |
Orthopedic shoe addition, insole, felt covered with leather |
| L3530 |
Ortho shoe add half sole |
Orthopedic shoe addition, sole, half |
| L3540 |
Ortho shoe add full sole |
Orthopedic shoe addition, sole, full |
| L3550 |
O shoe add standard toe tap |
Orthopedic shoe addition, toe tap standard |
| L3560 |
O shoe add horseshoe toe tap |
Orthopedic shoe addition, toe tap, horseshoe |
| L3570 |
O shoe add instep extension |
Orthopedic shoe addition, special extension to instep (leather with eyelets) |
| L3580 |
O shoe add instep velcro clo |
Orthopedic shoe addition, convert instep to velcro closure |
| L3590 |
O shoe convert to sof counte |
Orthopedic shoe addition, convert firm shoe counter to soft counter |
| L3595 |
Ortho shoe add march bar |
Orthopedic shoe addition, march bar |
| L3600 |
Trans shoe calip plate exist |
Transfer of an orthosis from one shoe to another, caliper plate, existing |
| L3610 |
Trans shoe caliper plate new |
Transfer of an orthosis from one shoe to another, caliper plate, new |
| L3620 |
Trans shoe solid stirrup exi |
Transfer of an orthosis from one shoe to another, solid stirrup, existing |
| L3630 |
Trans shoe solid stirrup new |
Transfer of an orthosis from one shoe to another, solid stirrup, new |
| L3640 |
Shoe dennis browne splint bo |
Transfer of an orthosis from one shoe to another, dennis browne splint (riveton), both shoes |
| L3649 |
Orthopedic shoe modifica nos |
Orthopedic shoe, modification, addition or transfer, not otherwise specified |
| L3650 |
So 8 abd restraint pre ots |
Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf |
| L3660 |
So 8 ab rstr can/web pre ots |
Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf |
| L3670 |
So acro/clav can web pre ots |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
| L3671 |
So cap design w/o jnts cf |
Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| L3674 |
So airplane w/wo joint cf |
Shoulder orthosis, abduction positioning (airplane design), thoracic component and support bar, with or without nontorsion joint/turnbuckle, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| L3675 |
So vest canvas/web pre ots |
Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf |
| L3677 |
So hard plas stabili pre cst |
Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L3678 |
So hard plas stabili pre ots |
Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated, off-the-shelf |
| L3702 |
Eo w/o joints cf |
Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| L3710 |
Eo elas w/metal jnts pre ots |
Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf |
| L3720 |
Forearm/arm cuffs free motio |
Elbow orthosis, double upright with forearm/arm cuffs, free motion, custom fabricated |
| L3730 |
Forearm/arm cuffs ext/flex a |
Elbow orthosis, double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated |
| L3740 |
Cuffs adj lock w/ active con |
Elbow orthosis, double upright with forearm/arm cuffs, adjustable position lock with active control, custom fabricated |
| L3760 |
Eo adj jt prefab custom fit |
Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L3761 |
Eo, adj lock joint prefab ot |
Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, off-the-shelf |
| L3762 |
Eo rigid w/o joints pre ots |
Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf |
| L3763 |
Ewho rigid w/o jnts cf |
Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| L3764 |
Ewho w/joint(s) cf |
Elbow wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| L3765 |
Ewhfo rigid w/o jnts cf |
Elbow wrist hand finger orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| L3766 |
Ewhfo w/joint(s) cf |
Elbow wrist hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| L3806 |
Whfo w/joint(s) custom fab |
Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment |
| L3807 |
Whfo w/o joints pre cst |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L3808 |
Whfo, rigid w/o joints |
Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment |
| L3809 |
Whfo w/o joints pre ots |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
| L3891 |
Torsion mechanism wrist/elbo |
Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each |
| L3900 |
Hinge extension/flex wrist/f |
Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, wrist or finger driven, custom fabricated |
| L3901 |
Hinge ext/flex wrist finger |
Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom fabricated |
| L3904 |
Whfo electric custom fitted |
Wrist hand finger orthosis, external powered, electric, custom fabricated |
| L3905 |
Who w/nontorsion jnt(s) cf |
Wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| L3906 |
Who w/o joints cf |
Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| L3908 |
Who cock-up nonmolde pre ots |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
| L3912 |
Hfo flexion glove pre ots |
Hand finger orthosis (hfo), flexion glove with elastic finger control, prefabricated, off-the-shelf |
| L3913 |
Hfo w/o joints cf |
Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| L3915 |
Who nontorsion jnts pre cst |
Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L3916 |
Who nontorsion jnts pre ots |
Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf |
| L3917 |
Metacarp fx orthosis pre cst |
Hand orthosis, metacarpal fracture orthosis, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L3918 |
Metacarp fx orthosis pre ots |
Hand orthosis, metacarpal fracture orthosis, prefabricated, off-the-shelf |
| L3919 |
Ho w/o joints cf |
Hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| L3921 |
Hfo w/joint(s) cf |
Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| L3923 |
Hfo without joints pre cst |
Hand finger orthosis, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L3924 |
Hfo without joints pre ots |
Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, off-the-shelf |
| L3925 |
Fo pip dip jnt/sprng pre ots |
Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf |
| L3927 |
Fo pip dip no jt spr pre ots |
Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), without joint/spring, extension/flexion (e.g., static or ring type), may include soft interface material, prefabricated, off-the-shelf |
| L3929 |
Hfo nontorsion jnts pre cst |
Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L3930 |
Hfo nontorsion jnts pre ots |
Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, off-the-shelf |
| L3931 |
Whfo nontorsion joint prefab |
Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, includes fitting and adjustment |
| L3933 |
Fo w/o joints cf |
Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment |
| L3935 |
Fo nontorsion joint cf |
Finger orthosis, nontorsion joint, may include soft interface, custom fabricated, includes fitting and adjustment |
| L3956 |
Add joint upper ext orthosis |
Addition of joint to upper extremity orthosis, any material; per joint |
| L3960 |
Sewho airplan desig abdu pos |
Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment |
| L3961 |
Sewho cap design w/o jnts cf |
Shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| L3962 |
Sewho erbs palsey design abd |
Shoulder elbow wrist hand orthosis, abduction positioning, erb's palsey design, prefabricated, includes fitting and adjustment |
| L3967 |
Sewho airplane w/o jnts cf |
Shoulder elbow wrist hand orthosis, abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| L3971 |
Sewho cap design w/jnt(s) cf |
Shoulder elbow wrist hand orthosis, shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| L3973 |
Sewho airplane w/jnt(s) cf |
Shoulder elbow wrist hand orthosis, abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| L3975 |
Sewhfo cap design w/o jnt cf |
Shoulder elbow wrist hand finger orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| L3976 |
Sewhfo airplane w/o jnts cf |
Shoulder elbow wrist hand finger orthosis, abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| L3977 |
Sewhfo cap desgn w/jnt(s) cf |
Shoulder elbow wrist hand finger orthosis, shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| L3978 |
Sewhfo airplane w/jnt(s) cf |
Shoulder elbow wrist hand finger orthosis, abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| L3980 |
Up ext fx orthos humeral nos |
Upper extremity fracture orthosis, humeral, prefabricated, includes fitting and adjustment |
| L3981 |
Ue fx orth shoul cap forearm |
Upper extremity fracture orthosis, humeral, prefabricated, includes shoulder cap design, with or without joints, forearm section, may include soft interface, straps, includes fitting and adjustments |
| L3982 |
Upper ext fx orthosis rad/ul |
Upper extremity fracture orthosis, radius/ulnar, prefabricated, includes fitting and adjustment |
| L3984 |
Upper ext fx orthosis wrist |
Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment |
| L3995 |
Sock fracture or equal each |
Addition to upper extremity orthosis, sock, fracture or equal, each |
| L3999 |
Upper limb orthosis nos |
Upper limb orthosis, not otherwise specified |
