| Field Name |
Field Value |
| Healthcare Common Procedure Coding System Code |
L4631 |
| HCPCS Sequence Number |
0010 |
| HCPCS Record Identification Code |
3 - First line of procedure record also contains detail information in positions 92-275 |
| HCPCS Long Description |
Ankle foot orthosis, walking boot type, varus/valgus correction, rocker bottom, anterior tibial shell, soft interface, custom arch support, plastic or other material, includes straps and closures, custom fabricated |
| HCPCS Short Description |
Afo, walk boot type, cus fab |
| HCPCS Pricing Indicator Code 1 |
38 - Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) |
| HCPCS Multiple Pricing Indicator Code |
A - Not applicable as HCPCS priced under one methodology |
| HCPCS Coverage Code |
C - Carrier judgment |
| HCPCS Berenson-Eggers Type Of Service Code |
D1F - Prosthetic/Orthotic devices |
| HCPCS Type Of Service Code 1 |
P - Lump sum purchase of DME, prosthetics, orthotics |
| HCPCS Anesthesia Base Unit Quantity |
0 |
| HCPCS Code Added Date |
1/1/2011 |
| HCPCS Action Effective Date |
1/1/2011 |
| HCPCS Action Code |
N - No maintenance for this code |