| L0112 |
Cranial cervical orthosis |
Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated |
| L0113 |
Cranial cervical torticollis |
Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment |
| L0120 |
Cerv flex n/adj foam pre ots |
Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar) |
| L0130 |
Flex thermoplastic collar mo |
Cervical, flexible, thermoplastic collar, molded to patient |
| L0140 |
Cervical semi-rigid adjustab |
Cervical, semi-rigid, adjustable (plastic collar) |
| L0150 |
Cerv semi-rig adj molded chn |
Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibular/occipital piece) |
| L0160 |
Cerv sr wire occ/man pre ots |
Cervical, semi-rigid, wire frame occipital/mandibular support, prefabricated, off-the-shelf |
| L0170 |
Cervical collar molded to pt |
Cervical, collar, molded to patient model |
| L0172 |
Cerv col sr foam 2pc pre ots |
Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf |
| L0174 |
Cerv sr 2pc thor ext pre ots |
Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf |
| L0180 |
Cer post col occ/man sup adj |
Cervical, multiple post collar, occipital/mandibular supports, adjustable |
| L0190 |
Cerv collar supp adj cerv ba |
Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars (somi, guilford, taylor types) |
| L0200 |
Cerv col supp adj bar & thor |
Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars, and thoracic extension |
| L0220 |
Thor rib belt custom fabrica |
Thoracic, rib belt, custom fabricated |
| L0450 |
Tlso flex trunk/thor pre ots |
Tlso, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf |
| L0452 |
Tlso flex custom fab thoraci |
Tlso, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, custom fabricated |
| L0454 |
Tlso trnk sj-t9 pre cst |
Tlso flexible, provides trunk support, extends from sacrococcygeal junction to above t-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L0455 |
Tlso flex trnk sj-t9 pre ots |
Tlso, flexible, provides trunk support, extends from sacrococcygeal junction to above t-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf |
| L0456 |
Tlso flex trnk sj-ss pre cst |
Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L0457 |
Tlso flex trnk sj-ss pre ots |
Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated, off-the-shelf |
| L0458 |
Tlso 2mod symphis-xipho pre |
Tlso, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment |
| L0460 |
Tlso 2 shl symphys-stern cst |
Tlso, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L0462 |
Tlso 3mod sacro-scap pre |
Tlso, triplanar control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment |
| L0464 |
Tlso 4mod sacro-scap pre |
Tlso, triplanar control, modular segmented spinal system, four rigid plastic shells, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment |
| L0466 |
Tlso r fram soft ant pre cst |
Tlso, sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L0467 |
Tlso r fram soft pre ots |
Tlso, sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated, off-the-shelf |
| L0468 |
Tlso rig fram pelvic pre cst |
Tlso, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal, and coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L0469 |
Tlso rig fram pelvic pre ots |
Tlso, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal and coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated, off-the-shelf |
| L0470 |
Tlso rigid frame pre subclav |
Tlso, triplanar control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction to scapula, lateral strength provided by pelvic, thoracic, and lateral frame pieces, rotational strength provided by subclavicular extensions, restricts gross trunk motion in sagittal, coronal, and transverse planes, provides intracavitary pressure to reduce load on the intervertebral disks, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment |
| L0472 |
Tlso rigid frame hyperex pre |
Tlso, triplanar control, hyperextension, rigid anterior and lateral frame extends from symphysis pubis to sternal notch with two anterior components (one pubic and one sternal), posterior and lateral pads with straps and closures, limits spinal flexion, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment |
| L0480 |
Tlso rigid plastic custom fa |
Tlso, triplanar control, one piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated |
| L0482 |
Tlso rigid lined custom fab |
Tlso, triplanar control, one piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated |
| L0484 |
Tlso rigid plastic cust fab |
Tlso, triplanar control, two piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated |
| L0486 |
Tlso rigidlined cust fab two |
Tlso, triplanar control, two piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated |
| L0488 |
Tlso rigid lined pre one pie |
Tlso, triplanar control, one piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, prefabricated, includes fitting and adjustment |
| L0490 |
Tlso rigid plastic pre one |
Tlso, sagittal-coronal control, one piece rigid plastic shell, with overlapping reinforced anterior, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates at or before the t-9 vertebra, anterior extends from symphysis pubis to xiphoid, anterior opening, restricts gross trunk motion in sagittal and coronal planes, prefabricated, includes fitting and adjustment |
| L0491 |
Tlso 2 piece rigid shell |
Tlso, sagittal-coronal control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal and coronal planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment |
| L0492 |
Tlso 3 piece rigid shell |
Tlso, sagittal-coronal control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal and coronal planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment |
| L0621 |
Sio flex pelvic/sacr pre ots |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
| L0622 |
Sio flex pelvisacral custom |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated |
| L0623 |
Sio rig pnl pelv/sac pre ots |
Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
| L0624 |
Sio panel custom |
Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels placed over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated |
| L0625 |
Lo flex l1-below l5 pre ots |
Lumbar orthosis, flexible, provides lumbar support, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf |
| L0626 |
Lo sag rig pnl stays pre cst |
Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L0627 |
Lo sag ri an/pos pnl pre cst |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L0628 |
Lso flex no ri stays pre ots |
Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
| L0629 |
Lso flex w/rigid stays cust |
Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, custom fabricated |
| L0630 |
Lso r post pnl sj-t9 pre cst |
Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L0631 |
Lso sag r an/pos pnl pre cst |
Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L0632 |
Lso sag rigid frame cust |
Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, custom fabricated |
| L0633 |
Lso sc r pos/lat pnl pre cst |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L0634 |
Lso flexion control custom |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, custom fabricated |
| L0635 |
Lso sagit rigid panel prefab |
Lumbar-sacral orthosis, sagittal-coronal control, lumbar flexion, rigid posterior frame/panel(s), lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, prefabricated, includes fitting and adjustment |
| L0636 |
Lso sagittal rigid panel cus |
Lumbar sacral orthosis, sagittal-coronal control, lumbar flexion, rigid posterior frame/panels, lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, custom fabricated |
| L0637 |
Lso sc r ant/pos pnl pre cst |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L0638 |
Lso sag-coronal panel custom |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, custom fabricated |
| L0639 |
Lso s/c shell/panel prefab |
Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L0640 |
Lso s/c shell/panel custom |
Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, custom fabricated |
| L0641 |
Lo rig pos pnl l1-l5 pre ots |
Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
| L0642 |
Lo sag ri an/pos pnl pre ots |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
| L0643 |
Lso sag ctr rigi pos pre ots |
Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
| L0648 |
Lso sag r an/pos pnl pre ots |
Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
| L0649 |
Lso sc r pos/lat pnl pre ots |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
| L0650 |
Lso sc r ant/pos pnl pre ots |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
| L0651 |
Lso sag-co shell pnl pre ots |
Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, prefabricated, off-the-shelf |
| L0700 |
Ctlso a-p-l control molded |
Cervical-thoracic-lumbar-sacral-orthoses (ctlso), anterior-posterior-lateral control, molded to patient model, (minerva type) |
| L0710 |
Ctlso a-p-l control w/ inter |
Ctlso, anterior-posterior-lateral-control, molded to patient model, with interface material, (minerva type) |
| L0810 |
Halo cervical into jckt vest |
Halo procedure, cervical halo incorporated into jacket vest |
| L0820 |
Halo cervical into body jack |
Halo procedure, cervical halo incorporated into plaster body jacket |
| L0830 |
Halo cerv into milwaukee typ |
Halo procedure, cervical halo incorporated into milwaukee type orthosis |
| L0859 |
Mri compatible system |
Addition to halo procedure, magnetic resonance image compatible systems, rings and pins, any material |
| L0861 |
Halo repl liner/interface |
Addition to halo procedure, replacement liner/interface material |
| L0970 |
Tlso corset front |
Tlso, corset front |
| L0972 |
Lso corset front |
Lso, corset front |
| L0974 |
Tlso full corset |
Tlso, full corset |
| L0976 |
Lso full corset |
Lso, full corset |
| L0978 |
Axillary crutch extension |
Axillary crutch extension |
| L0980 |
Peroneal straps pair pre ots |
Peroneal straps, prefabricated, off-the-shelf, pair |
| L0982 |
Stocking sup grips 4 pre ots |
Stocking supporter grips, prefabricated, off-the-shelf, set of four (4) |
| L0984 |
Protect body sock ea pre ots |
Protective body sock, prefabricated, off-the-shelf, each |
| L0999 |
Add to spinal orthosis nos |
Addition to spinal orthosis, not otherwise specified |
| L1 |
Separately payable lab test |
Provider attestation that the hospital laboratory test(s) is not packaged under the hospital opps |
| L1000 |
Ctlso milwauke initial model |
Cervical-thoracic-lumbar-sacral orthosis (ctlso) (milwaukee), inclusive of furnishing initial orthosis, including model |
| L1001 |
Ctlso infant immobilizer |
Cervical thoracic lumbar sacral orthosis, immobilizer, infant size, prefabricated, includes fitting and adjustment |
| L1005 |
Tension based scoliosis orth |
Tension based scoliosis orthosis and accessory pads, includes fitting and adjustment |
| L1010 |
Ctlso axilla sling |
Addition to cervical-thoracic-lumbar-sacral orthosis (ctlso) or scoliosis orthosis, axilla sling |
| L1020 |
Kyphosis pad |
Addition to ctlso or scoliosis orthosis, kyphosis pad |
| L1025 |
Kyphosis pad floating |
Addition to ctlso or scoliosis orthosis, kyphosis pad, floating |
| L1030 |
Lumbar bolster pad |
Addition to ctlso or scoliosis orthosis, lumbar bolster pad |
| L1040 |
Lumbar or lumbar rib pad |
Addition to ctlso or scoliosis orthosis, lumbar or lumbar rib pad |
| L1050 |
Sternal pad |
Addition to ctlso or scoliosis orthosis, sternal pad |
| L1060 |
Thoracic pad |
Addition to ctlso or scoliosis orthosis, thoracic pad |
| L1070 |
Trapezius sling |
Addition to ctlso or scoliosis orthosis, trapezius sling |
| L1080 |
Outrigger |
Addition to ctlso or scoliosis orthosis, outrigger |
| L1085 |
Outrigger bil w/ vert extens |
Addition to ctlso or scoliosis orthosis, outrigger, bilateral with vertical extensions |
| L1090 |
Lumbar sling |
Addition to ctlso or scoliosis orthosis, lumbar sling |
| L1100 |
Ring flange plastic/leather |
Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather |
| L1110 |
Ring flange plas/leather mol |
Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather, molded to patient model |
| L1120 |
Covers for upright each |
Addition to ctlso, scoliosis orthosis, cover for upright, each |
| L1200 |
Furnsh initial orthosis only |
Thoracic-lumbar-sacral-orthosis (tlso), inclusive of furnishing initial orthosis only |
| L1210 |
Lateral thoracic extension |
Addition to tlso, (low profile), lateral thoracic extension |
| L1220 |
Anterior thoracic extension |
Addition to tlso, (low profile), anterior thoracic extension |
| L1230 |
Milwaukee type superstructur |
Addition to tlso, (low profile), milwaukee type superstructure |
| L1240 |
Lumbar derotation pad |
Addition to tlso, (low profile), lumbar derotation pad |
| L1250 |
Anterior asis pad |
Addition to tlso, (low profile), anterior asis pad |
| L1260 |
Anterior thoracic derotation |
Addition to tlso, (low profile), anterior thoracic derotation pad |
| L1270 |
Abdominal pad |
Addition to tlso, (low profile), abdominal pad |
| L1280 |
Rib gusset (elastic) each |
Addition to tlso, (low profile), rib gusset (elastic), each |
| L1290 |
Lateral trochanteric pad |
Addition to tlso, (low profile), lateral trochanteric pad |
| L1300 |
Body jacket mold to patient |
Other scoliosis procedure, body jacket molded to patient model |
| L1310 |
Post-operative body jacket |
Other scoliosis procedure, post-operative body jacket |
| L1320 |
Pectus carinatum ortho cust |
Thoracic, pectus carinatum orthosis, sternal compression, rigid circumferential frame with anterior and posterior rigid pads, custom fabricated |
| L1499 |
Spinal orthosis nos |
Spinal orthosis, not otherwise specified |
| L1600 |
Ho flex frejka w/cov pre cst |
Hip orthosis, abduction control of hip joints, flexible, frejka type with cover, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an inidividual with expertise |
| L1610 |
Ho frejka cov only pre cst |
Hip orthosis, abduction control of hip joints, flexible, (frejka cover only), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L1620 |
Ho flex pavlik harns pre cst |
Hip orthosis, abduction control of hip joints, flexible, (pavlik harness), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L1630 |
Abduct control hip semi-flex |
Hip orthosis, abduction control of hip joints, semi-flexible (von rosen type), custom fabricated |
| L1640 |
Pelv band/spread bar thigh c |
Hip orthosis, abduction control of hip joints, static, pelvic band or spreader bar, thigh cuffs, custom fabricated |
| L1650 |
Ho abduction hip adjustable |
Hip orthosis, abduction control of hip joints, static, adjustable, (ilfled type), prefabricated, includes fitting and adjustment |
| L1652 |
Ho bi thighcuffs w sprdr bar |
Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, includes fitting and adjustment, any type |
| L1660 |
Ho abduction static plastic |
Hip orthosis, abduction control of hip joints, static, plastic, prefabricated, includes fitting and adjustment |
| L1680 |
Pelvic & hip control thigh c |
Hip orthosis, abduction control of hip joints, dynamic, pelvic control, adjustable hip motion control, thigh cuffs (rancho hip action type), custom fabricated |
| L1681 |
Ho bilateral hip abduction |
Hip 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 |
| L1685 |
Post-op hip abduct custom fa |
Hip orthosis, abduction control of hip joint, postoperative hip abduction type, custom fabricated |
| L1686 |
Ho post-op hip abduction |
Hip orthosis, abduction control of hip joint, postoperative hip abduction type, prefabricated, includes fitting and adjustment |
| L1690 |
Combination bilateral ho |
Combination, bilateral, lumbo-sacral, hip, femur orthosis providing adduction and internal rotation control, prefabricated, includes fitting and adjustment |
| L1700 |
Leg perthes orth toronto typ |
Legg perthes orthosis, (toronto type), custom fabricated |
| L1710 |
Legg perthes orth newington |
Legg perthes orthosis, (newington type), custom fabricated |
| L1720 |
Legg perthes orthosis trilat |
Legg perthes orthosis, trilateral, (tachdijan type), custom fabricated |
| L1730 |
Legg perthes orth scottish r |
Legg perthes orthosis, (scottish rite type), custom fabricated |
| L1755 |
Legg perthes patten bottom t |
Legg perthes orthosis, (patten bottom type), custom fabricated |
| L1810 |
Ko elastic with joints |
Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L1812 |
Ko elastic w/joints pre ots |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
| L1820 |
Ko elas w/ condyle pads & jo |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, includes fitting and adjustment |
| L1830 |
Ko immob canvas long pre ots |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
| L1831 |
Knee orth pos locking joint |
Knee orthosis, locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment |
| L1832 |
Ko adj jnt pos r sup pre cst |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L1833 |
Ko adj jnt pos r sup pre ots |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
| L1834 |
Ko w/0 joint rigid molded to |
Knee orthosis, without knee joint, rigid, custom fabricated |
| L1836 |
Ko rigid w/o joints pre ots |
Knee orthosis, rigid, without joint(s), includes soft interface material, prefabricated, off-the-shelf |
| L1840 |
Ko derot ant cruciate custom |
Knee orthosis, derotation, medial-lateral, anterior cruciate ligament, custom fabricated |
| L1843 |
Ko single upright pre cst |
Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L1844 |
Ko w/adj jt rot cntrl molded |
Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated |
| L1845 |
Ko double upright pre cst |
Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L1846 |
Ko w adj flex/ext rotat mold |
Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated |
| L1847 |
Ko dbl upright w/air pre cst |
Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L1848 |
Ko dbl upright w/air pre ots |
Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated, off-the-shelf |
| L1850 |
Ko swedish type pre ots |
Knee orthosis, swedish type, prefabricated, off-the-shelf |
| L1851 |
Ko single upright prefab ots |
Knee orthosis (ko), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf |
| L1852 |
Ko double upright prefab ots |
Knee orthosis (ko), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf |
| L1860 |
Ko supracondylar socket mold |
Knee orthosis, modification of supracondylar prosthetic socket, custom fabricated (sk) |
| L1900 |
Afo sprng wir drsflx calf bd |
Ankle foot orthosis, spring wire, dorsiflexion assist calf band, custom fabricated |
| L1902 |
Afo ankle gauntlet pre ots |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
| L1904 |
Afo molded ankle gauntlet |
Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated |
| L1906 |
Afo multilig ank sup pre ots |
Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf |
| L1907 |
Afo supramalleolar custom |
Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated |
| L1910 |
Afo sing bar clasp attach sh |
Ankle foot orthosis, posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment |
| L1920 |
Afo sing upright w/ adjust s |
Ankle foot orthosis, single upright with static or adjustable stop (phelps or perlstein type), custom fabricated |
| L1930 |
Afo plastic |
Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment |
| L1932 |
Afo rig ant tib prefab tcf/= |
Afo, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, includes fitting and adjustment |
| L1940 |
Afo molded to patient plasti |
Ankle foot orthosis, plastic or other material, custom fabricated |
| L1945 |
Afo molded plas rig ant tib |
Ankle foot orthosis, plastic, rigid anterior tibial section (floor reaction), custom fabricated |
| L1950 |
Afo spiral molded to pt plas |
Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic, custom fabricated |
| L1951 |
Afo spiral prefabricated |
Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, includes fitting and adjustment |
| L1960 |
Afo pos solid ank plastic mo |
Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated |
| L1970 |
Afo plastic molded w/ankle j |
Ankle foot orthosis, plastic with ankle joint, custom fabricated |
| L1971 |
Afo w/ankle joint, prefab |
Ankle foot orthosis, plastic or other material with ankle joint, prefabricated, includes fitting and adjustment |
| L1980 |
Afo sing solid stirrup calf |
Ankle foot orthosis, single upright free plantar dorsiflexion, solid stirrup, calf band/cuff (single bar 'bk' orthosis), custom fabricated |
| L1990 |
Afo doub solid stirrup calf |
Ankle foot orthosis, double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar 'bk' orthosis), custom fabricated |
| L2000 |
Kafo sing fre stirr thi/calf |
Knee ankle foot orthosis, single upright, free knee, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar 'ak' orthosis), custom fabricated |
| L2005 |
Kafo sng/dbl mechanical act |
Knee ankle foot orthosis, any material, single or double upright, stance control, automatic lock and swing phase release, any type activation, includes ankle joint, any type, custom fabricated |
| L2006 |
Kaf sng/dbl swg/stn mcpr cus |
Knee 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 |
| L2010 |
Kafo sng solid stirrup w/o j |
Knee ankle foot orthosis, single upright, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar 'ak' orthosis), without knee joint, custom fabricated |
| L2020 |
Kafo dbl solid stirrup band/ |
Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs (double bar 'ak' orthosis), custom fabricated |
| L2030 |
Kafo dbl solid stirrup w/o j |
Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs, (double bar 'ak' orthosis), without knee joint, custom fabricated |
| L2034 |
Kafo pla sin up w/wo k/a cus |
Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, medial lateral rotation control, with or without free motion ankle, custom fabricated |
| L2035 |
Kafo plastic pediatric size |
Knee ankle foot orthosis, full plastic, static (pediatric size), without free motion ankle, prefabricated, includes fitting and adjustment |
| L2036 |
Kafo plas doub free knee mol |
Knee ankle foot orthosis, full plastic, double upright, with or without free motion knee, with or without free motion ankle, custom fabricated |
| L2037 |
Kafo plas sing free knee mol |
Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, with or without free motion ankle, custom fabricated |
| L2038 |
Kafo w/o joint multi-axis an |
Knee ankle foot orthosis, full plastic, with or without free motion knee, multi-axis ankle, custom fabricated |
| L2040 |
Hkafo torsion bil rot straps |
Hip knee ankle foot orthosis, torsion control, bilateral rotation straps, pelvic band/belt, custom fabricated |
| L2050 |
Hkafo torsion cable hip pelv |
Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, hip joint, pelvic band/belt, custom fabricated |
| L2060 |
Hkafo torsion ball bearing j |
Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, ball bearing hip joint, pelvic band/ belt, custom fabricated |
| L2070 |
Hkafo torsion unilat rot str |
Hip knee ankle foot orthosis, torsion control, unilateral rotation straps, pelvic band/belt, custom fabricated |
| L2080 |
Hkafo unilat torsion cable |
Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, hip joint, pelvic band/belt, custom fabricated |
| L2090 |
Hkafo unilat torsion ball br |
Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, ball bearing hip joint, pelvic band/ belt, custom fabricated |
| L2106 |
Afo tib fx cast plaster mold |
Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, thermoplastic type casting material, custom fabricated |
| L2108 |
Afo tib fx cast molded to pt |
Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, custom fabricated |
| L2112 |
Afo tibial fracture soft |
Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment |
| L2114 |
Afo tib fx semi-rigid |
Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment |
| L2116 |
Afo tibial fracture rigid |
Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, rigid, prefabricated, includes fitting and adjustment |
| L2126 |
Kafo fem fx cast thermoplas |
Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, thermoplastic type casting material, custom fabricated |
| L2128 |
Kafo fem fx cast molded to p |
Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, custom fabricated |
| L2132 |
Kafo femoral fx cast soft |
Kafo, fracture orthosis, femoral fracture cast orthosis, soft, prefabricated, includes fitting and adjustment |
| L2134 |
Kafo fem fx cast semi-rigid |
Kafo, fracture orthosis, femoral fracture cast orthosis, semi-rigid, prefabricated, includes fitting and adjustment |
| L2136 |
Kafo femoral fx cast rigid |
Kafo, fracture orthosis, femoral fracture cast orthosis, rigid, prefabricated, includes fitting and adjustment |
| L2180 |
Plas shoe insert w ank joint |
Addition to lower extremity fracture orthosis, plastic shoe insert with ankle joints |
| L2182 |
Drop lock knee |
Addition to lower extremity fracture orthosis, drop lock knee joint |
| L2184 |
Limited motion knee joint |
Addition to lower extremity fracture orthosis, limited motion knee joint |
| L2186 |
Adj motion knee jnt lerman t |
Addition to lower extremity fracture orthosis, adjustable motion knee joint, lerman type |
| L2188 |
Quadrilateral brim |
Addition to lower extremity fracture orthosis, quadrilateral brim |
| L2190 |
Waist belt |
Addition to lower extremity fracture orthosis, waist belt |
| L2192 |
Pelvic band & belt thigh fla |
Addition to lower extremity fracture orthosis, hip joint, pelvic band, thigh flange, and pelvic belt |
| L2200 |
Limited ankle motion ea jnt |
Addition to lower extremity, limited ankle motion, each joint |
| L2210 |
Dorsiflexion assist each joi |
Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint |
| L2220 |
Dorsi & plantar flex ass/res |
Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint |
| L2230 |
Split flat caliper stirr & p |
Addition to lower extremity, split flat caliper stirrups and plate attachment |
| L2232 |
Rocker bottom, contact afo |
Addition to lower extremity orthosis, rocker bottom for total contact ankle foot orthosis, for custom fabricated orthosis only |
| L2240 |
Round caliper and plate atta |
Addition to lower extremity, round caliper and plate attachment |
| L2250 |
Foot plate molded stirrup at |
Addition to lower extremity, foot plate, molded to patient model, stirrup attachment |
| L2260 |
Reinforced solid stirrup |
Addition to lower extremity, reinforced solid stirrup (scott-craig type) |
| L2265 |
Long tongue stirrup |
Addition to lower extremity, long tongue stirrup |
| L2270 |
Varus/valgus strap padded/li |
Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad |
| L2275 |
Plastic mod low ext pad/line |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
| L2280 |
Molded inner boot |
Addition to lower extremity, molded inner boot |
| L2300 |
Abduction bar jointed adjust |
Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable |
| L2310 |
Abduction bar-straight |
Addition to lower extremity, abduction bar-straight |
| L2320 |
Non-molded lacer |
Addition to lower extremity, non-molded lacer, for custom fabricated orthosis only |
| L2330 |
Lacer molded to patient mode |
Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only |
| L2335 |
Anterior swing band |
Addition to lower extremity, anterior swing band |
| L2340 |
Pre-tibial shell molded to p |
Addition to lower extremity, pre-tibial shell, molded to patient model |
| L2350 |
Prosthetic type socket molde |
Addition to lower extremity, prosthetic type, (bk) socket, molded to patient model, (used for 'ptb' 'afo' orthoses) |
| L2360 |
Extended steel shank |
Addition to lower extremity, extended steel shank |
| L2370 |
Patten bottom |
Addition to lower extremity, patten bottom |
| L2375 |
Torsion ank & half solid sti |
Addition to lower extremity, torsion control, ankle joint and half solid stirrup |
| L2380 |
Torsion straight knee joint |
Addition to lower extremity, torsion control, straight knee joint, each joint |
| L2385 |
Straight knee joint heavy du |
Addition to lower extremity, straight knee joint, heavy duty, each joint |
| L2387 |
Add le poly knee custom kafo |
Addition to lower extremity, polycentric knee joint, for custom fabricated knee ankle foot orthosis, each joint |
| L2390 |
Offset knee joint each |
Addition to lower extremity, offset knee joint, each joint |
| L2395 |
Offset knee joint heavy duty |
Addition to lower extremity, offset knee joint, heavy duty, each joint |
| L2397 |
Suspension sleeve lower ext |
Addition to lower extremity orthosis, suspension sleeve |
| L2405 |
Knee joint drop lock ea jnt |
Addition to knee joint, drop lock, each |
| L2415 |
Knee joint cam lock each joi |
Addition to knee lock with integrated release mechanism (bail, cable, or equal), any material, each joint |
| L2425 |
Knee disc/dial lock/adj flex |
Addition to knee joint, disc or dial lock for adjustable knee flexion, each joint |
| L2430 |
Knee jnt ratchet lock ea jnt |
Addition to knee joint, ratchet lock for active and progressive knee extension, each joint |
| L2492 |
Knee lift loop drop lock rin |
Addition to knee joint, lift loop for drop lock ring |
| L2500 |
Thi/glut/ischia wgt bearing |
Addition to lower extremity, thigh/weight bearing, gluteal/ ischial weight bearing, ring |
| L2510 |
Th/wght bear quad-lat brim m |
Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, molded to patient model |
| L2520 |
Th/wght bear quad-lat brim c |
Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, custom fitted |
| L2525 |
Th/wght bear nar m-l brim mo |
Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim molded to patient model |
| L2526 |
Th/wght bear nar m-l brim cu |
Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim, custom fitted |
| L2530 |
Thigh/wght bear lacer non-mo |
Addition to lower extremity, thigh-weight bearing, lacer, non-molded |
| L2540 |
Thigh/wght bear lacer molded |
Addition to lower extremity, thigh/weight bearing, lacer, molded to patient model |
| L2550 |
Thigh/wght bear high roll cu |
Addition to lower extremity, thigh/weight bearing, high roll cuff |
| L2570 |
Hip clevis type 2 posit jnt |
Addition to lower extremity, pelvic control, hip joint, clevis type two position joint, each |
| L2580 |
Pelvic control pelvic sling |
Addition to lower extremity, pelvic control, pelvic sling |
| L2600 |
Hip clevis/thrust bearing fr |
Addition to lower extremity, pelvic control, hip joint, clevis type, or thrust bearing, free, each |
| L2610 |
Hip clevis/thrust bearing lo |
Addition to lower extremity, pelvic control, hip joint, clevis or thrust bearing, lock, each |
| L2620 |
Pelvic control hip heavy dut |
Addition to lower extremity, pelvic control, hip joint, heavy duty, each |
| L2622 |
Hip joint adjustable flexion |
Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each |
| L2624 |
Hip adj flex ext abduct cont |
Addition to lower extremity, pelvic control, hip joint, adjustable flexion, extension, abduction control, each |
| L2627 |
Plastic mold recipro hip & c |
Addition to lower extremity, pelvic control, plastic, molded to patient model, reciprocating hip joint and cables |
| L2628 |
Metal frame recipro hip & ca |
Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables |
| L2630 |
Pelvic control band & belt u |
Addition to lower extremity, pelvic control, band and belt, unilateral |
| L2640 |
Pelvic control band & belt b |
Addition to lower extremity, pelvic control, band and belt, bilateral |
| L2650 |
Pelv & thor control gluteal |
Addition to lower extremity, pelvic and thoracic control, gluteal pad, each |
| L2660 |
Thoracic control thoracic ba |
Addition to lower extremity, thoracic control, thoracic band |
| L2670 |
Thorac cont paraspinal uprig |
Addition to lower extremity, thoracic control, paraspinal uprights |
| L2680 |
Thorac cont lat support upri |
Addition to lower extremity, thoracic control, lateral support uprights |
| L2750 |
Plating chrome/nickel pr bar |
Addition to lower extremity orthosis, plating chrome or nickel, per bar |
| L2755 |
Carbon graphite lamination |
Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only |
| L2760 |
Extension per extension per |
Addition to lower extremity orthosis, extension, per extension, per bar (for lineal adjustment for growth) |
| L2768 |
Ortho sidebar disconnect |
Orthotic side bar disconnect device, per bar |
| L2780 |
Non-corrosive finish |
Addition to lower extremity orthosis, non-corrosive finish, per bar |
| L2785 |
Drop lock retainer each |
Addition to lower extremity orthosis, drop lock retainer, each |
| L2795 |
Knee control full kneecap |
Addition to lower extremity orthosis, knee control, full kneecap |
| L2800 |
Knee cap medial or lateral p |
Addition to lower extremity orthosis, knee control, knee cap, medial or lateral pull, for use with custom fabricated orthosis only |
| L2810 |
Knee control condylar pad |
Addition to lower extremity orthosis, knee control, condylar pad |
| L2820 |
Soft interface below knee se |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
| L2830 |
Soft interface above knee se |
Addition to lower extremity orthosis, soft interface for molded plastic, above knee section |
| L2840 |
Tibial length sock fx or equ |
Addition to lower extremity orthosis, tibial length sock, fracture or equal, each |
| L2850 |
Femoral lgth sock fx or equa |
Addition to lower extremity orthosis, femoral length sock, fracture or equal, each |
| L2861 |
Torsion mechanism knee/ankle |
Addition to lower extremity joint, knee or ankle, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each |
| L2999 |
Lower extremity orthosis nos |
Lower extremity orthoses, not otherwise specified |
| 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 |
| L4000 |
Repl girdle milwaukee orth |
Replace girdle for spinal orthosis (ctlso or so) |
| L4002 |
Replace strap, any orthosis |
Replacement strap, any orthosis, includes all components, any length, any type |
| L4010 |
Replace trilateral socket br |
Replace trilateral socket brim |
| L4020 |
Replace quadlat socket brim |
Replace quadrilateral socket brim, molded to patient model |
| L4030 |
Replace socket brim cust fit |
Replace quadrilateral socket brim, custom fitted |
| L4040 |
Replace molded thigh lacer |
Replace molded thigh lacer, for custom fabricated orthosis only |
| L4045 |
Replace non-molded thigh lac |
Replace non-molded thigh lacer, for custom fabricated orthosis only |
| L4050 |
Replace molded calf lacer |
Replace molded calf lacer, for custom fabricated orthosis only |
| L4055 |
Replace non-molded calf lace |
Replace non-molded calf lacer, for custom fabricated orthosis only |
| L4060 |
Replace high roll cuff |
Replace high roll cuff |
| L4070 |
Replace prox & dist upright |
Replace proximal and distal upright for kafo |
| L4080 |
Repl met band kafo-afo prox |
Replace metal bands kafo, proximal thigh |
| L4090 |
Repl met band kafo-afo calf/ |
Replace metal bands kafo-afo, calf or distal thigh |
| L4100 |
Repl leath cuff kafo prox th |
Replace leather cuff kafo, proximal thigh |
| L4110 |
Repl leath cuff kafo-afo cal |
Replace leather cuff kafo-afo, calf or distal thigh |
| L4130 |
Replace pretibial shell |
Replace pretibial shell |
| L4205 |
Ortho dvc repair per 15 min |
Repair of orthotic device, labor component, per 15 minutes |
| L4210 |
Orth dev repair/repl minor p |
Repair of orthotic device, repair or replace minor parts |
| L4350 |
Ankle control ortho pre ots |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
| L4360 |
Pneumat walking boot pre cst |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L4361 |
Pneuma/vac walk boot pre ots |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
| L4370 |
Pneum full leg splnt pre ots |
Pneumatic full leg splint, prefabricated, off-the-shelf |
| L4386 |
Non-pneum walk boot pre cst |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L4387 |
Non-pneum walk boot pre ots |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
| L4392 |
Replace afo soft interface |
Replacement, soft interface material, static afo |
| L4394 |
Replace foot drop spint |
Replace soft interface material, foot drop splint |
| L4396 |
Static or dynami afo pre cst |
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L4397 |
Static or dynami afo pre ots |
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf |
| L4398 |
Foot drop splint pre ots |
Foot drop splint, recumbent positioning device, prefabricated, off-the-shelf |
| L4631 |
Afo, walk boot type, cus fab |
Ankle foot orthosis, walking boot type, varus/valgus correction, rocker bottom, anterior tibial shell, soft interface, custom arch support, plastic or other material, includes straps and closures, custom fabricated |
| L5000 |
Sho insert w arch toe filler |
Partial foot, shoe insert with longitudinal arch, toe filler |
| L5010 |
Mold socket ank hgt w/ toe f |
Partial foot, molded socket, ankle height, with toe filler |
| L5020 |
Tibial tubercle hgt w/ toe f |
Partial foot, molded socket, tibial tubercle height, with toe filler |
| L5050 |
Ank symes mold sckt sach ft |
Ankle, symes, molded socket, sach foot |
| L5060 |
Symes met fr leath socket ar |
Ankle, symes, metal frame, molded leather socket, articulated ankle/foot |
| L5100 |
Molded socket shin sach foot |
Below knee, molded socket, shin, sach foot |
| L5105 |
Plast socket jts/thgh lacer |
Below knee, plastic socket, joints and thigh lacer, sach foot |
| L5150 |
Mold sckt ext knee shin sach |
Knee disarticulation (or through knee), molded socket, external knee joints, shin, sach foot |
| L5160 |
Mold socket bent knee shin s |
Knee disarticulation (or through knee), molded socket, bent knee configuration, external knee joints, shin, sach foot |
| L5200 |
Kne sing axis fric shin sach |
Above knee, molded socket, single axis constant friction knee, shin, sach foot |
| L5210 |
No knee/ankle joints w/ ft b |
Above knee, short prosthesis, no knee joint ('stubbies'), with foot blocks, no ankle joints, each |
| L5220 |
No knee joint with artic ali |
Above knee, short prosthesis, no knee joint ('stubbies'), with articulated ankle/foot, dynamically aligned, each |
| L5230 |
Fem focal defic constant fri |
Above knee, for proximal femoral focal deficiency, constant friction knee, shin, sach foot |
| L5250 |
Hip canad sing axi cons fric |
Hip disarticulation, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot |
| L5270 |
Tilt table locking hip sing |
Hip disarticulation, tilt table type; molded socket, locking hip joint, single axis constant friction knee, shin, sach foot |
| L5280 |
Hemipelvect canad sing axis |
Hemipelvectomy, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot |
| L5301 |
Bk mold socket sach ft endo |
Below knee, molded socket, shin, sach foot, endoskeletal system |
| L5312 |
Knee disart, sach ft, endo |
Knee disarticulation (or through knee), molded socket, single axis knee, pylon, sach foot, endoskeletal system |
| L5321 |
Ak open end sach |
Above knee, molded socket, open end, sach foot, endoskeletal system, single axis knee |
| L5331 |
Hip disart canadian sach ft |
Hip disarticulation, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot |
| L5341 |
Hemipelvectomy canadian sach |
Hemipelvectomy, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot |
| L5400 |
Postop dress & 1 cast chg bk |
Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment, suspension, and one cast change, below knee |
| L5410 |
Postop dsg bk ea add cast ch |
Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension, below knee, each additional cast change and realignment |
| L5420 |
Postop dsg & 1 cast chg ak/d |
Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension and one cast change 'ak' or knee disarticulation |
| L5430 |
Postop dsg ak ea add cast ch |
Immediate post surgical or early fitting, application of initial rigid dressing, incl. fitting, alignment and supension, 'ak' or knee disarticulation, each additional cast change and realignment |
| L5450 |
Postop app non-wgt bear dsg |
Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, below knee |
| L5460 |
Postop app non-wgt bear dsg |
Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, above knee |
| L5500 |
Init bk ptb plaster direct |
Initial, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed |
| L5505 |
Init ak ischal plstr direct |
Initial, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed |
| L5510 |
Prep bk ptb plaster molded |
Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model |
| L5520 |
Perp bk ptb thermopls direct |
Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed |
| L5530 |
Prep bk ptb thermopls molded |
Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model |
| L5535 |
Prep bk ptb open end socket |
Preparatory, below knee 'ptb' type socket, non-alignable system, no cover, sach foot, prefabricated, adjustable open end socket |
| L5540 |
Prep bk ptb laminated socket |
Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, laminated socket, molded to model |
| L5560 |
Prep ak ischial plast molded |
Preparatory, above knee- knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model |
| L5570 |
Prep ak ischial direct form |
Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed |
| L5580 |
Prep ak ischial thermo mold |
Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model |
| L5585 |
Prep ak ischial open end |
Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, prefabricated adjustable open end socket |
| L5590 |
Prep ak ischial laminated |
Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon no cover, sach foot, laminated socket, molded to model |
| L5595 |
Hip disartic sach thermopls |
Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, thermoplastic or equal, molded to patient model |
| L5600 |
Hip disart sach laminat mold |
Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, laminated socket, molded to patient model |
| L5610 |
Above knee hydracadence |
Addition to lower extremity, endoskeletal system, above knee, hydracadence system |
| L5611 |
Ak 4 bar link w/fric swing |
Addition to lower extremity, endoskeletal system, above knee - knee disarticulation, 4 bar linkage, with friction swing phase control |
| L5613 |
Ak 4 bar ling w/hydraul swig |
Addition to lower extremity, endoskeletal system, above knee-knee disarticulation, 4 bar linkage, with hydraulic swing phase control |
| L5614 |
4-bar link above knee w/swng |
Addition to lower extremity, exoskeletal system, above knee-knee disarticulation, 4 bar linkage, with pneumatic swing phase control |
| L5615 |
Ak 4 bar link hydl swg/stanc |
Addition, endoskeletal knee-shin system, 4 bar linkage or multiaxial, fluid swing and stance phase control |
| L5616 |
Ak univ multiplex sys frict |
Addition to lower extremity, endoskeletal system, above knee, universal multiplex system, friction swing phase control |
| L5617 |
Ak/bk self-aligning unit ea |
Addition to lower extremity, quick change self-aligning unit, above knee or below knee, each |
| L5618 |
Test socket symes |
Addition to lower extremity, test socket, symes |
| L5620 |
Test socket below knee |
Addition to lower extremity, test socket, below knee |
| L5622 |
Test socket knee disarticula |
Addition to lower extremity, test socket, knee disarticulation |
| L5624 |
Test socket above knee |
Addition to lower extremity, test socket, above knee |
| L5626 |
Test socket hip disarticulat |
Addition to lower extremity, test socket, hip disarticulation |
| L5628 |
Test socket hemipelvectomy |
Addition to lower extremity, test socket, hemipelvectomy |
| L5629 |
Below knee acrylic socket |
Addition to lower extremity, below knee, acrylic socket |
| L5630 |
Syme typ expandabl wall sckt |
Addition to lower extremity, symes type, expandable wall socket |
| L5631 |
Ak/knee disartic acrylic soc |
Addition to lower extremity, above knee or knee disarticulation, acrylic socket |
| L5632 |
Symes type ptb brim design s |
Addition to lower extremity, symes type, 'ptb' brim design socket |
| L5634 |
Symes type poster opening so |
Addition to lower extremity, symes type, posterior opening (canadian) socket |
| L5636 |
Symes type medial opening so |
Addition to lower extremity, symes type, medial opening socket |
| L5637 |
Below knee total contact |
Addition to lower extremity, below knee, total contact |
| L5638 |
Below knee leather socket |
Addition to lower extremity, below knee, leather socket |
| L5639 |
Below knee wood socket |
Addition to lower extremity, below knee, wood socket |
| L5640 |
Knee disarticulat leather so |
Addition to lower extremity, knee disarticulation, leather socket |
| L5642 |
Above knee leather socket |
Addition to lower extremity, above knee, leather socket |
| L5643 |
Hip flex inner socket ext fr |
Addition to lower extremity, hip disarticulation, flexible inner socket, external frame |
| L5644 |
Above knee wood socket |
Addition to lower extremity, above knee, wood socket |
| L5645 |
Bk flex inner socket ext fra |
Addition to lower extremity, below knee, flexible inner socket, external frame |
| L5646 |
Below knee cushion socket |
Addition to lower extremity, below knee, air, fluid, gel or equal, cushion socket |
| L5647 |
Below knee suction socket |
Addition to lower extremity, below knee suction socket |
| L5648 |
Above knee cushion socket |
Addition to lower extremity, above knee, air, fluid, gel or equal, cushion socket |
| L5649 |
Isch containmt/narrow m-l so |
Addition to lower extremity, ischial containment/narrow m-l socket |
| L5650 |
Tot contact ak/knee disart s |
Additions to lower extremity, total contact, above knee or knee disarticulation socket |
| L5651 |
Ak flex inner socket ext fra |
Addition to lower extremity, above knee, flexible inner socket, external frame |
| L5652 |
Suction susp ak/knee disart |
Addition to lower extremity, suction suspension, above knee or knee disarticulation socket |
| L5653 |
Knee disart expand wall sock |
Addition to lower extremity, knee disarticulation, expandable wall socket |
| L5654 |
Socket insert symes |
Addition to lower extremity, socket insert, symes, (kemblo, pelite, aliplast, plastazote or equal) |
| L5655 |
Socket insert below knee |
Addition to lower extremity, socket insert, below knee (kemblo, pelite, aliplast, plastazote or equal) |
| L5656 |
Socket insert knee articulat |
Addition to lower extremity, socket insert, knee disarticulation (kemblo, pelite, aliplast, plastazote or equal) |
| L5658 |
Socket insert above knee |
Addition to lower extremity, socket insert, above knee (kemblo, pelite, aliplast, plastazote or equal) |
| L5661 |
Multi-durometer symes |
Addition to lower extremity, socket insert, multi-durometer symes |
| L5665 |
Multi-durometer below knee |
Addition to lower extremity, socket insert, multi-durometer, below knee |
| L5666 |
Below knee cuff suspension |
Addition to lower extremity, below knee, cuff suspension |
| L5668 |
Bk molded distal cushion |
Addition to lower extremity, below knee, molded distal cushion |
| L5670 |
Bk molded supracondylar susp |
Addition to lower extremity, below knee, molded supracondylar suspension ('pts' or similar) |
| L5671 |
Bk/ak locking mechanism |
Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert |
| L5672 |
Bk removable medial brim sus |
Addition to lower extremity, below knee, removable medial brim suspension |
| L5673 |
Socket insert w lock mech |
Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism |
| L5676 |
Bk knee joints single axis p |
Additions to lower extremity, below knee, knee joints, single axis, pair |
| L5677 |
Bk knee joints polycentric p |
Additions to lower extremity, below knee, knee joints, polycentric, pair |
| L5678 |
Bk joint covers pair |
Additions to lower extremity, below knee, joint covers, pair |
| L5679 |
Socket insert w/o lock mech |
Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism |
| L5680 |
Bk thigh lacer non-molded |
Addition to lower extremity, below knee, thigh lacer, nonmolded |
| L5681 |
Intl custm cong/latyp insert |
Addition to lower extremity, below knee/above knee, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l5673 or l5679) |
| L5682 |
Bk thigh lacer glut/ischia m |
Addition to lower extremity, below knee, thigh lacer, gluteal/ischial, molded |
| L5683 |
Initial custom socket insert |
Addition to lower extremity, below knee/above knee, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l5673 or l5679) |
| L5684 |
Bk fork strap |
Addition to lower extremity, below knee, fork strap |
| L5685 |
Below knee sus/seal sleeve |
Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each |
| L5686 |
Bk back check |
Addition to lower extremity, below knee, back check (extension control) |
| L5688 |
Bk waist belt webbing |
Addition to lower extremity, below knee, waist belt, webbing |
| L5690 |
Bk waist belt padded and lin |
Addition to lower extremity, below knee, waist belt, padded and lined |
| L5692 |
Ak pelvic control belt light |
Addition to lower extremity, above knee, pelvic control belt, light |
| L5694 |
Ak pelvic control belt pad/l |
Addition to lower extremity, above knee, pelvic control belt, padded and lined |
| L5695 |
Ak sleeve susp neoprene/equa |
Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each |
| L5696 |
Ak/knee disartic pelvic join |
Addition to lower extremity, above knee or knee disarticulation, pelvic joint |
| L5697 |
Ak/knee disartic pelvic band |
Addition to lower extremity, above knee or knee disarticulation, pelvic band |
| L5698 |
Ak/knee disartic silesian ba |
Addition to lower extremity, above knee or knee disarticulation, silesian bandage |
| L5699 |
Shoulder harness |
All lower extremity prostheses, shoulder harness |
| L5700 |
Replace socket below knee |
Replacement, socket, below knee, molded to patient model |
| L5701 |
Replace socket above knee |
Replacement, socket, above knee/knee disarticulation, including attachment plate, molded to patient model |
| L5702 |
Replace socket hip |
Replacement, socket, hip disarticulation, including hip joint, molded to patient model |
| L5703 |
Symes ankle w/o (sach) foot |
Ankle, symes, molded to patient model, socket without solid ankle cushion heel (sach) foot, replacement only |
| L5704 |
Custom shape cover bk |
Custom shaped protective cover, below knee |
| L5705 |
Custom shape cover ak |
Custom shaped protective cover, above knee |
| L5706 |
Custom shape cvr knee disart |
Custom shaped protective cover, knee disarticulation |
| L5707 |
Custom shape cvr hip disart |
Custom shaped protective cover, hip disarticulation |
| L5710 |
Kne-shin exo sng axi mnl loc |
Addition, exoskeletal knee-shin system, single axis, manual lock |
| L5711 |
Knee-shin exo mnl lock ultra |
Additions exoskeletal knee-shin system, single axis, manual lock, ultra-light material |
| L5712 |
Knee-shin exo frict swg & st |
Addition, exoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee) |
| L5714 |
Knee-shin exo variable frict |
Addition, exoskeletal knee-shin system, single axis, variable friction swing phase control |
| L5716 |
Knee-shin exo mech stance ph |
Addition, exoskeletal knee-shin system, polycentric, mechanical stance phase lock |
| L5718 |
Knee-shin exo frct swg & sta |
Addition, exoskeletal knee-shin system, polycentric, friction swing and stance phase control |
| L5722 |
Knee-shin pneum swg frct exo |
Addition, exoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control |
| L5724 |
Knee-shin exo fluid swing ph |
Addition, exoskeletal knee-shin system, single axis, fluid swing phase control |
| L5726 |
Knee-shin ext jnts fld swg e |
Addition, exoskeletal knee-shin system, single axis, external joints fluid swing phase control |
| L5728 |
Knee-shin fluid swg & stance |
Addition, exoskeletal knee-shin system, single axis, fluid swing and stance phase control |
| L5780 |
Knee-shin pneum/hydra pneum |
Addition, exoskeletal knee-shin system, single axis, pneumatic/hydra pneumatic swing phase control |
| L5781 |
Lower limb pros vacuum pump |
Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system |
| L5782 |
Hd low limb pros vacuum pump |
Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy duty |
| L5783 |
Add low ext mec limb vol sys |
Addition to lower extremity, user adjustable, mechanical, residual limb volume management system |
| L5785 |
Exoskeletal bk ultralt mater |
Addition, exoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) |
| L5790 |
Exoskeletal ak ultra-light m |
Addition, exoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal) |
| L5795 |
Exoskel hip ultra-light mate |
Addition, exoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal) |
| L5810 |
Endoskel knee-shin mnl lock |
Addition, endoskeletal knee-shin system, single axis, manual lock |
| L5811 |
Endo knee-shin mnl lck ultra |
Addition, endoskeletal knee-shin system, single axis, manual lock, ultra-light material |
| L5812 |
Endo knee-shin frct swg & st |
Addition, endoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee) |
| L5814 |
Endo knee-shin hydral swg ph |
Addition, endoskeletal knee-shin system, polycentric, hydraulic swing phase control, mechanical stance phase lock |
| L5816 |
Endo knee-shin polyc mch sta |
Addition, endoskeletal knee-shin system, polycentric, mechanical stance phase lock |
| L5818 |
Endo knee-shin frct swg & st |
Addition, endoskeletal knee-shin system, polycentric, friction swing, and stance phase control |
| L5822 |
Endo knee-shin pneum swg frc |
Addition, endoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control |
| L5824 |
Endo knee-shin fluid swing p |
Addition, endoskeletal knee-shin system, single axis, fluid swing phase control |
| L5826 |
Miniature knee joint |
Addition, endoskeletal knee-shin system, single axis, hydraulic swing phase control, with miniature high activity frame |
| L5828 |
Endo knee-shin fluid swg/sta |
Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control |
| L5830 |
Endo knee-shin pneum/swg pha |
Addition, endoskeletal knee-shin system, single axis, pneumatic/ swing phase control |
| L5840 |
Multi-axial knee/shin system |
Addition, endoskeletal knee/shin system, 4-bar linkage or multiaxial, pneumatic swing phase control |
| L5841 |
Addition endoskletl knee-shi |
Addition, endoskeletal knee-shin system, polycentric, pneumatic swing, and stance phase control |
| L5845 |
Knee-shin sys stance flexion |
Addition, endoskeletal, knee-shin system, stance flexion feature, adjustable |
| L5848 |
Knee-shin sys hydraul stance |
Addition to endoskeletal knee-shin system, fluid stance extension, dampening feature, with or without adjustability |
| L5850 |
Endo ak/hip knee extens assi |
Addition, endoskeletal system, above knee or hip disarticulation, knee extension assist |
| L5855 |
Mech hip extension assist |
Addition, endoskeletal system, hip disarticulation, mechanical hip extension assist |
| L5856 |
Elec knee-shin swing/stance |
Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type |
| L5857 |
Elec knee-shin swing only |
Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type |
| L5858 |
Stance phase only |
Addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type |
| L5859 |
Knee-shin pro flex/ext cont |
Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s) |
| L5910 |
Endo below knee alignable sy |
Addition, endoskeletal system, below knee, alignable system |
| L5920 |
Endo ak/hip alignable system |
Addition, endoskeletal system, above knee or hip disarticulation, alignable system |
| L5925 |
Above knee manual lock |
Addition, endoskeletal system, above knee, knee disarticulation or hip disarticulation, manual lock |
| L5926 |
Endoskel posit rotat unit |
Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type |
| L5930 |
High activity knee frame |
Addition, endoskeletal system, high activity knee control frame |
| L5940 |
Endo bk ultra-light material |
Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) |
| L5950 |
Endo ak ultra-light material |
Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal) |
| L5960 |
Endo hip ultra-light materia |
Addition, endoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal) |
| L5961 |
Endo poly hip, pneu/hyd/rot |
Addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion and/or extension control |
| L5962 |
Below knee flex cover system |
Addition, endoskeletal system, below knee, flexible protective outer surface covering system |
| L5964 |
Above knee flex cover system |
Addition, endoskeletal system, above knee, flexible protective outer surface covering system |
| L5966 |
Hip flexible cover system |
Addition, endoskeletal system, hip disarticulation, flexible protective outer surface covering system |
| L5968 |
Multiaxial ankle w dorsiflex |
Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature |
| L5969 |
Ak/ft power asst incl motors |
Addition, endoskeletal ankle-foot or ankle system, power assist, includes any type motor(s) |
| L5970 |
Foot external keel sach foot |
All lower extremity prostheses, foot, external keel, sach foot |
| L5971 |
Sach foot, replacement |
All lower extremity prosthesis, solid ankle cushion heel (sach) foot, replacement only |
| L5972 |
Flexible keel foot |
All lower extremity prostheses, foot, flexible keel |
| L5973 |
Ank-foot sys dors-plant flex |
Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source |
| L5974 |
Foot single axis ankle/foot |
All lower extremity prostheses, foot, single axis ankle/foot |
| L5975 |
Combo ankle/foot prosthesis |
All lower extremity prosthesis, combination single axis ankle and flexible keel foot |
| L5976 |
Energy storing foot |
All lower extremity prostheses, energy storing foot (seattle carbon copy ii or equal) |
| L5978 |
Ft prosth multiaxial ankl/ft |
All lower extremity prostheses, foot, multiaxial ankle/foot |
| L5979 |
Multi-axial ankle/ft prosth |
All lower extremity prosthesis, multi-axial ankle, dynamic response foot, one piece system |
| L5980 |
Flex foot system |
All lower extremity prostheses, flex foot system |
| L5981 |
Flex-walk sys low ext prosth |
All lower extremity prostheses, flex-walk system or equal |
| L5982 |
Exoskeletal axial rotation u |
All exoskeletal lower extremity prostheses, axial rotation unit |
| L5984 |
Endoskeletal axial rotation |
All endoskeletal lower extremity prosthesis, axial rotation unit, with or without adjustability |
| L5985 |
Lwr ext dynamic prosth pylon |
All endoskeletal lower extremity prostheses, dynamic prosthetic pylon |
| L5986 |
Multi-axial rotation unit |
All lower extremity prostheses, multi-axial rotation unit ('mcp' or equal) |
| L5987 |
Shank ft w vert load pylon |
All lower extremity prosthesis, shank foot system with vertical loading pylon |
| L5988 |
Vertical shock reducing pylo |
Addition to lower limb prosthesis, vertical shock reducing pylon feature |
| L5990 |
User adjustable heel height |
Addition to lower extremity prosthesis, user adjustable heel height |
| L5991 |
Low pros ext osseo connector |
Addition to lower extremity prostheses, osseointegrated external prosthetic connector |
| L5999 |
Lowr extremity prosthes nos |
Lower extremity prosthesis, not otherwise specified |
| L6000 |
Part hand thumb rem |
Partial hand, thumb remaining |
| L6010 |
Part hand little/ring |
Partial hand, little and/or ring finger remaining |
| L6020 |
Part hand no fingers |
Partial hand, no finger remaining |
| L6025 |
Part hand disart myoelectric |
Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectric control of terminal device |
| L6026 |
Part hand myo exclu term dev |
Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectric control of terminal device, excludes terminal device(s) |
| L6050 |
Wrst mld sck flx hng tri pad |
Wrist disarticulation, molded socket, flexible elbow hinges, triceps pad |
| L6055 |
Wrst mold sock w/exp interfa |
Wrist disarticulation, molded socket with expandable interface, flexible elbow hinges, triceps pad |
| L6100 |
Elb mold sock flex hinge pad |
Below elbow, molded socket, flexible elbow hinge, triceps pad |
| L6110 |
Elbow mold sock suspension t |
Below elbow, molded socket, (muenster or northwestern suspension types) |
| L6120 |
Elbow mold doub splt soc ste |
Below elbow, molded double wall split socket, step-up hinges, half cuff |
| L6130 |
Elbow stump activated lock h |
Below elbow, molded double wall split socket, stump activated locking hinge, half cuff |
| L6200 |
Elbow mold outsid lock hinge |
Elbow disarticulation, molded socket, outside locking hinge, forearm |
| L6205 |
Elbow molded w/ expand inter |
Elbow disarticulation, molded socket with expandable interface, outside locking hinges, forearm |
| L6250 |
Elbow inter loc elbow forarm |
Above elbow, molded double wall socket, internal locking elbow, forearm |
| L6300 |
Shlder disart int lock elbow |
Shoulder disarticulation, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm |
| L6310 |
Shoulder passive restor comp |
Shoulder disarticulation, passive restoration (complete prosthesis) |
| L6320 |
Shoulder passive restor cap |
Shoulder disarticulation, passive restoration (shoulder cap only) |
| L6350 |
Thoracic intern lock elbow |
Interscapular thoracic, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm |
| L6360 |
Thoracic passive restor comp |
Interscapular thoracic, passive restoration (complete prosthesis) |
| L6370 |
Thoracic passive restor cap |
Interscapular thoracic, passive restoration (shoulder cap only) |
| L6380 |
Postop dsg cast chg wrst/elb |
Immediate post surgical or early fitting, application of initial rigid dressing, including fitting alignment and suspension of components, and one cast change, wrist disarticulation or below elbow |
| L6382 |
Postop dsg cast chg elb dis/ |
Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, elbow disarticulation or above elbow |
| L6384 |
Postop dsg cast chg shlder/t |
Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, shoulder disarticulation or interscapular thoracic |
| L6386 |
Postop ea cast chg & realign |
Immediate post surgical or early fitting, each additional cast change and realignment |
| L6388 |
Postop applicat rigid dsg on |
Immediate post surgical or early fitting, application of rigid dressing only |
| L6400 |
Below elbow prosth tiss shap |
Below elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping |
| L6450 |
Elb disart prosth tiss shap |
Elbow disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping |
| L6500 |
Above elbow prosth tiss shap |
Above elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping |
| L6550 |
Shldr disar prosth tiss shap |
Shoulder disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping |
| L6570 |
Scap thorac prosth tiss shap |
Interscapular thoracic, molded socket, endoskeletal system, including soft prosthetic tissue shaping |
| L6580 |
Wrist/elbow bowden cable mol |
Preparatory, wrist disarticulation or below elbow, single wall plastic socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden cable control, usmc or equal pylon, no cover, molded to patient model |
| L6582 |
Wrist/elbow bowden cbl dir f |
Preparatory, wrist disarticulation or below elbow, single wall socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden cable control, usmc or equal pylon, no cover, direct formed |
| L6584 |
Elbow fair lead cable molded |
Preparatory, elbow disarticulation or above elbow, single wall plastic socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or equal pylon, no cover, molded to patient model |
| L6586 |
Elbow fair lead cable dir fo |
Preparatory, elbow disarticulation or above elbow, single wall socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or equal pylon, no cover, direct formed |
| L6588 |
Shdr fair lead cable molded |
Preparatory, shoulder disarticulation or interscapular thoracic, single wall plastic socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, usmc or equal pylon, no cover, molded to patient model |
| L6590 |
Shdr fair lead cable direct |
Preparatory, shoulder disarticulation or interscapular thoracic, single wall socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, usmc or equal pylon, no cover, direct formed |
| L6600 |
Polycentric hinge pair |
Upper extremity additions, polycentric hinge, pair |
| L6605 |
Single pivot hinge pair |
Upper extremity additions, single pivot hinge, pair |
| L6610 |
Flexible metal hinge pair |
Upper extremity additions, flexible metal hinge, pair |
| L6611 |
Additional switch, ext power |
Addition to upper extremity prosthesis, external powered, additional switch, any type |
| L6615 |
Disconnect locking wrist uni |
Upper extremity addition, disconnect locking wrist unit |
| L6616 |
Disconnect insert locking wr |
Upper extremity addition, additional disconnect insert for locking wrist unit, each |
| L6620 |
Flexion/extension wrist unit |
Upper extremity addition, flexion/extension wrist unit, with or without friction |
| L6621 |
Flex/ext wrist w/wo friction |
Upper extremity prosthesis addition, flexion/extension wrist with or without friction, for use with external powered terminal device |
| L6623 |
Spring-ass rot wrst w/ latch |
Upper extremity addition, spring assisted rotational wrist unit with latch release |
| L6624 |
Flex/ext/rotation wrist unit |
Upper extremity addition, flexion/extension and rotation wrist unit |
| L6625 |
Rotation wrst w/ cable lock |
Upper extremity addition, rotation wrist unit with cable lock |
| L6628 |
Quick disconn hook adapter o |
Upper extremity addition, quick disconnect hook adapter, otto bock or equal |
| L6629 |
Lamination collar w/ couplin |
Upper extremity addition, quick disconnect lamination collar with coupling piece, otto bock or equal |
| L6630 |
Stainless steel any wrist |
Upper extremity addition, stainless steel, any wrist |
| L6632 |
Latex suspension sleeve each |
Upper extremity addition, latex suspension sleeve, each |
| L6635 |
Lift assist for elbow |
Upper extremity addition, lift assist for elbow |
| L6637 |
Nudge control elbow lock |
Upper extremity addition, nudge control elbow lock |
| L6638 |
Elec lock on manual pw elbow |
Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow |
| L6640 |
Shoulder abduction joint pai |
Upper extremity additions, shoulder abduction joint, pair |
| L6641 |
Excursion amplifier pulley t |
Upper extremity addition, excursion amplifier, pulley type |
| L6642 |
Excursion amplifier lever ty |
Upper extremity addition, excursion amplifier, lever type |
| L6645 |
Shoulder flexion-abduction j |
Upper extremity addition, shoulder flexion-abduction joint, each |
| L6646 |
Multipo locking shoulder jnt |
Upper extremity addition, shoulder joint, multipositional locking, flexion, adjustable abduction friction control, for use with body powered or external powered system |
| L6647 |
Shoulder lock actuator |
Upper extremity addition, shoulder lock mechanism, body powered actuator |
| L6648 |
Ext pwrd shlder lock/unlock |
Upper extremity addition, shoulder lock mechanism, external powered actuator |
| L6650 |
Shoulder universal joint |
Upper extremity addition, shoulder universal joint, each |
| L6655 |
Standard control cable extra |
Upper extremity addition, standard control cable, extra |
| L6660 |
Heavy duty control cable |
Upper extremity addition, heavy duty control cable |
| L6665 |
Teflon or equal cable lining |
Upper extremity addition, teflon, or equal, cable lining |
| L6670 |
Hook to hand cable adapter |
Upper extremity addition, hook to hand, cable adapter |
| L6672 |
Harness chest/shlder saddle |
Upper extremity addition, harness, chest or shoulder, saddle type |
| L6675 |
Harness figure of 8 sing con |
Upper extremity addition, harness, (e.g., figure of eight type), single cable design |
| L6676 |
Harness figure of 8 dual con |
Upper extremity addition, harness, (e.g., figure of eight type), dual cable design |
| L6677 |
Ue triple control harness |
Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow |
| L6680 |
Test sock wrist disart/bel e |
Upper extremity addition, test socket, wrist disarticulation or below elbow |
| L6682 |
Test sock elbw disart/above |
Upper extremity addition, test socket, elbow disarticulation or above elbow |
| L6684 |
Test socket shldr disart/tho |
Upper extremity addition, test socket, shoulder disarticulation or interscapular thoracic |
| L6686 |
Suction socket |
Upper extremity addition, suction socket |
| L6687 |
Frame typ socket bel elbow/w |
Upper extremity addition, frame type socket, below elbow or wrist disarticulation |
| L6688 |
Frame typ sock above elb/dis |
Upper extremity addition, frame type socket, above elbow or elbow disarticulation |
| L6689 |
Frame typ socket shoulder di |
Upper extremity addition, frame type socket, shoulder disarticulation |
| L6690 |
Frame typ sock interscap-tho |
Upper extremity addition, frame type socket, interscapular-thoracic |
| L6691 |
Removable insert each |
Upper extremity addition, removable insert, each |
| L6692 |
Silicone gel insert or equal |
Upper extremity addition, silicone gel insert or equal, each |
| L6693 |
Lockingelbow forearm cntrbal |
Upper extremity addition, locking elbow, forearm counterbalance |
| L6694 |
Elbow socket ins use w/lock |
Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism |
| L6695 |
Elbow socket ins use w/o lck |
Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism |
| L6696 |
Cus elbo skt in for con/atyp |
Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695) |
| L6697 |
Cus elbo skt in not con/atyp |
Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695) |
| L6698 |
Below/above elbow lock mech |
Addition to upper extremity prosthesis, below elbow/above elbow, lock mechanism, excludes socket insert |
| L6703 |
Term dev, passive hand mitt |
Terminal device, passive hand/mitt, any material, any size |
| L6704 |
Term dev, sport/rec/work att |
Terminal device, sport/recreational/work attachment, any material, any size |
| L6706 |
Term dev mech hook vol open |
Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined |
| L6707 |
Term dev mech hook vol close |
Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined |
| L6708 |
Term dev mech hand vol open |
Terminal device, hand, mechanical, voluntary opening, any material, any size |
| L6709 |
Term dev mech hand vol close |
Terminal device, hand, mechanical, voluntary closing, any material, any size |
| L6711 |
Ped term dev, hook, vol open |
Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined, pediatric |
| L6712 |
Ped term dev, hook, vol clos |
Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined, pediatric |
| L6713 |
Ped term dev, hand, vol open |
Terminal device, hand, mechanical, voluntary opening, any material, any size, pediatric |
| L6714 |
Ped term dev, hand, vol clos |
Terminal device, hand, mechanical, voluntary closing, any material, any size, pediatric |
| L6715 |
Term device, multi art digit |
Terminal device, multiple articulating digit, includes motor(s), initial issue or replacement |
| L6721 |
Hook/hand, hvy dty, vol open |
Terminal device, hook or hand, heavy duty, mechanical, voluntary opening, any material, any size, lined or unlined |
| L6722 |
Hook/hand, hvy dty, vol clos |
Terminal device, hook or hand, heavy duty, mechanical, voluntary closing, any material, any size, lined or unlined |
| L6805 |
Term dev modifier wrist unit |
Addition to terminal device, modifier wrist unit |
| L6810 |
Term dev precision pinch dev |
Addition to terminal device, precision pinch device |
| L6880 |
Elec hand ind art digits |
Electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s) |
| L6881 |
Term dev auto grasp feature |
Automatic grasp feature, addition to upper limb electric prosthetic terminal device |
| L6882 |
Microprocessor control uplmb |
Microprocessor control feature, addition to upper limb prosthetic terminal device |
| L6883 |
Replc sockt below e/w disa |
Replacement socket, below elbow/wrist disarticulation, molded to patient model, for use with or without external power |
| L6884 |
Replc sockt above elbow disa |
Replacement socket, above elbow/elbow disarticulation, molded to patient model, for use with or without external power |
| L6885 |
Replc sockt shldr dis/interc |
Replacement socket, shoulder disarticulation/interscapular thoracic, molded to patient model, for use with or without external power |
| L6890 |
Prefab glove for term device |
Addition to upper extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment |
| L6895 |
Custom glove for term device |
Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated |
| L6900 |
Hand restorat thumb/1 finger |
Hand restoration (casts, shading and measurements included), partial hand, with glove, thumb or one finger remaining |
| L6905 |
Hand restoration multiple fi |
Hand restoration (casts, shading and measurements included), partial hand, with glove, multiple fingers remaining |
| L6910 |
Hand restoration no fingers |
Hand restoration (casts, shading and measurements included), partial hand, with glove, no fingers remaining |
| L6915 |
Hand restoration replacmnt g |
Hand restoration (shading, and measurements included), replacement glove for above |
| L6920 |
Wrist disarticul switch ctrl |
Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal, switch, cables, two batteries and one charger, switch control of terminal device |
| L6925 |
Wrist disart myoelectronic c |
Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device |
| L6930 |
Below elbow switch control |
Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device |
| L6935 |
Below elbow myoelectronic ct |
Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device |
| L6940 |
Elbow disarticulation switch |
Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device |
| L6945 |
Elbow disart myoelectronic c |
Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device |
| L6950 |
Above elbow switch control |
Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device |
| L6955 |
Above elbow myoelectronic ct |
Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device |
| L6960 |
Shldr disartic switch contro |
Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device |
| L6965 |
Shldr disartic myoelectronic |
Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device |
| L6970 |
Interscapular-thor switch ct |
Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device |
| L6975 |
Interscap-thor myoelectronic |
Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device |
| L7007 |
Adult electric hand |
Electric hand, switch or myoelectric controlled, adult |
| L7008 |
Pediatric electric hand |
Electric hand, switch or myoelectric, controlled, pediatric |
| L7009 |
Adult electric hook |
Electric hook, switch or myoelectric controlled, adult |
| L7040 |
Prehensile actuator |
Prehensile actuator, switch controlled |
| L7045 |
Pediatric electric hook |
Electric hook, switch or myoelectric controlled, pediatric |
| L7170 |
Electronic elbow hosmer swit |
Electronic elbow, hosmer or equal, switch controlled |
| L7180 |
Electronic elbow sequential |
Electronic elbow, microprocessor sequential control of elbow and terminal device |
| L7181 |
Electronic elbo simultaneous |
Electronic elbow, microprocessor simultaneous control of elbow and terminal device |
| L7185 |
Electron elbow adolescent sw |
Electronic elbow, adolescent, variety village or equal, switch controlled |
| L7186 |
Electron elbow child switch |
Electronic elbow, child, variety village or equal, switch controlled |
| L7190 |
Elbow adolescent myoelectron |
Electronic elbow, adolescent, variety village or equal, myoelectronically controlled |
| L7191 |
Elbow child myoelectronic ct |
Electronic elbow, child, variety village or equal, myoelectronically controlled |
| L7259 |
Electronic wrist rotator any |
Electronic wrist rotator, any type |
| L7260 |
Electron wrist rotator otto |
Electronic wrist rotator, otto bock or equal |
| L7261 |
Electron wrist rotator utah |
Electronic wrist rotator, for utah arm |
| L7360 |
Six volt bat otto bock/eq ea |
Six volt battery, each |
| L7362 |
Battery chrgr six volt otto |
Battery charger, six volt, each |
| L7364 |
Twelve volt battery utah/equ |
Twelve volt battery, each |
| L7366 |
Battery chrgr 12 volt utah/e |
Battery charger, twelve volt, each |
| L7367 |
Replacemnt lithium ionbatter |
Lithium ion battery, rechargeable, replacement |
| L7368 |
Lithium ion battery charger |
Lithium ion battery charger, replacement only |
| L7400 |
Add ue prost be/wd, ultlite |
Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultralight material (titanium, carbon fiber or equal) |
| L7401 |
Add ue prost a/e ultlite mat |
Addition to upper extremity prosthesis, above elbow disarticulation, ultralight material (titanium, carbon fiber or equal) |
| L7402 |
Add ue prost s/d ultlite mat |
Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultralight material (titanium, carbon fiber or equal) |
| L7403 |
Add ue prost b/e acrylic |
Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material |
| L7404 |
Add ue prost a/e acrylic |
Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material |
| L7405 |
Add ue prost s/d acrylic |
Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material |
| L7499 |
Upper extremity prosthes nos |
Upper extremity prosthesis, not otherwise specified |
| L7510 |
Prosthetic device repair rep |
Repair of prosthetic device, repair or replace minor parts |
| L7520 |
Repair prosthesis per 15 min |
Repair prosthetic device, labor component, per 15 minutes |
| L7600 |
Prosthetic donning sleeve |
Prosthetic donning sleeve, any material, each |
| L7700 |
Pros soc insert gasket/seal |
Gasket or seal, for use with prosthetic socket insert, any type, each |
| L7900 |
Male vacuum erection system |
Male vacuum erection system |
| L7902 |
Tension ring, vac erect dev |
Tension ring, for vacuum erection device, any type, replacement only, each |
| L8000 |
Mastectomy bra |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
| L8001 |
Breast prosthesis bra & form |
Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type |
| L8002 |
Brst prsth bra & bilat form |
Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type |
| L8010 |
Mastectomy sleeve |
Breast prosthesis, mastectomy sleeve |
| L8015 |
Ext breastprosthesis garment |
External breast prosthesis garment, with mastectomy form, post mastectomy |
| L8020 |
Mastectomy form |
Breast prosthesis, mastectomy form |
| L8030 |
Breast prosthes w/o adhesive |
Breast prosthesis, silicone or equal, without integral adhesive |
| L8031 |
Breast prosthesis w adhesive |
Breast prosthesis, silicone or equal, with integral adhesive |
| L8032 |
Reusable nipple prosthesis |
Nipple prosthesis, prefabricated, reusable, any type, each |
| L8033 |
Nipple prosthesis custom, ea |
Nipple prosthesis, custom fabricated, reusable, any material, any type, each |
| L8035 |
Custom breast prosthesis |
Custom breast prosthesis, post mastectomy, molded to patient model |
| L8039 |
Breast prosthesis nos |
Breast prosthesis, not otherwise specified |
| L8040 |
Nasal prosthesis |
Nasal prosthesis, provided by a non-physician |
| L8041 |
Midfacial prosthesis |
Midfacial prosthesis, provided by a non-physician |
| L8042 |
Orbital prosthesis |
Orbital prosthesis, provided by a non-physician |
| L8043 |
Upper facial prosthesis |
Upper facial prosthesis, provided by a non-physician |
| L8044 |
Hemi-facial prosthesis |
Hemi-facial prosthesis, provided by a non-physician |
| L8045 |
Auricular prosthesis |
Auricular prosthesis, provided by a non-physician |
| L8046 |
Partial facial prosthesis |
Partial facial prosthesis, provided by a non-physician |
| L8047 |
Nasal septal prosthesis |
Nasal septal prosthesis, provided by a non-physician |
| L8048 |
Unspec maxillofacial prosth |
Unspecified maxillofacial prosthesis, by report, provided by a non-physician |
| L8049 |
Repair maxillofacial prosth |
Repair or modification of maxillofacial prosthesis, labor component, 15 minute increments, provided by a non-physician |
| L8300 |
Truss single w/ standard pad |
Truss, single with standard pad |
| L8310 |
Truss double w/ standard pad |
Truss, double with standard pads |
| L8320 |
Truss addition to std pad wa |
Truss, addition to standard pad, water pad |
| L8330 |
Truss add to std pad scrotal |
Truss, addition to standard pad, scrotal pad |
| L8400 |
Sheath below knee |
Prosthetic sheath, below knee, each |
| L8410 |
Sheath above knee |
Prosthetic sheath, above knee, each |
| L8415 |
Sheath upper limb |
Prosthetic sheath, upper limb, each |
| L8417 |
Pros sheath/sock w gel cushn |
Prosthetic sheath/sock, including a gel cushion layer, below knee or above knee, each |
| L8420 |
Prosthetic sock multi ply bk |
Prosthetic sock, multiple ply, below knee, each |
| L8430 |
Prosthetic sock multi ply ak |
Prosthetic sock, multiple ply, above knee, each |
| L8435 |
Pros sock multi ply upper lm |
Prosthetic sock, multiple ply, upper limb, each |
| L8440 |
Shrinker below knee |
Prosthetic shrinker, below knee, each |
| L8460 |
Shrinker above knee |
Prosthetic shrinker, above knee, each |
| L8465 |
Shrinker upper limb |
Prosthetic shrinker, upper limb, each |
| L8470 |
Pros sock single ply bk |
Prosthetic sock, single ply, fitting, below knee, each |
| L8480 |
Pros sock single ply ak |
Prosthetic sock, single ply, fitting, above knee, each |
| L8485 |
Pros sock single ply upper l |
Prosthetic sock, single ply, fitting, upper limb, each |
| L8499 |
Unlisted misc prosthetic ser |
Unlisted procedure for miscellaneous prosthetic services |
| L8500 |
Artificial larynx |
Artificial larynx, any type |
| L8501 |
Tracheostomy speaking valve |
Tracheostomy speaking valve |
| L8505 |
Artificial larynx, accessory |
Artificial larynx replacement battery / accessory, any type |
| L8507 |
Trach-esoph voice pros pt in |
Tracheo-esophageal voice prosthesis, patient inserted, any type, each |
| L8509 |
Trach-esoph voice pros md in |
Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type |
| L8510 |
Voice amplifier |
Voice amplifier |
| L8511 |
Indwelling trach insert |
Insert for indwelling tracheoesophageal prosthesis, with or without valve, replacement only, each |
| L8512 |
Gel cap for trach voice pros |
Gelatin capsules or equivalent, for use with tracheoesophageal voice prosthesis, replacement only, per 10 |
| L8513 |
Trach pros cleaning device |
Cleaning device used with tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each |
| L8514 |
Repl trach puncture dilator |
Tracheoesophageal puncture dilator, replacement only, each |
| L8515 |
Gel cap app device for trach |
Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each |
| L8600 |
Implant breast silicone/eq |
Implantable breast prosthesis, silicone or equal |
| L8603 |
Collagen imp urinary 2.5 ml |
Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies |
| L8604 |
Dextranomer/hyaluronic acid |
Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, urinary tract, 1 ml, includes shipping and necessary supplies |
| L8605 |
Inj bulking agent anal canal |
Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, anal canal, 1 ml, includes shipping and necessary supplies |
| L8606 |
Synthetic implnt urinary 1ml |
Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe, includes shipping and necessary supplies |
| L8607 |
Inj vocal cord bulking agent |
Injectable bulking agent for vocal cord medialization, 0.1 ml, includes shipping and necessary supplies |
| L8608 |
Arg ii ext com/sup/acc misc |
Miscellaneous external component, supply or accessory for use with the argus ii retinal prosthesis system |
| L8609 |
Artificial cornea |
Artificial cornea |
| L8610 |
Ocular implant |
Ocular implant |
| L8612 |
Aqueous shunt prosthesis |
Aqueous shunt |
| L8613 |
Ossicular implant |
Ossicula implant |
| L8614 |
Cochlear device |
Cochlear device, includes all internal and external components |
| L8615 |
Coch implant headset replace |
Headset/headpiece for use with cochlear implant device, replacement |
| L8616 |
Coch implant microphone repl |
Microphone for use with cochlear implant device, replacement |
| L8617 |
Coch implant trans coil repl |
Transmitting coil for use with cochlear implant device, replacement |
| L8618 |
Coch implant tran cable repl |
Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement |
| L8619 |
Coch imp ext proc/contr rplc |
Cochlear implant, external speech processor and controller, integrated system, replacement |
| L8621 |
Repl zinc air battery |
Zinc air battery for use with cochlear implant device and auditory osseointegrated sound processors, replacement, each |
| L8622 |
Repl alkaline battery |
Alkaline battery for use with cochlear implant device, any size, replacement, each |
| L8623 |
Lith ion batt cid,non-earlvl |
Lithium ion battery for use with cochlear implant device speech processor, other than ear level, replacement, each |
| L8624 |
Lith ion batt cid, ear level |
Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement, each |
| L8625 |
Charger coch impl/aoi battry |
External recharging system for battery for use with cochlear implant or auditory osseointegrated device, replacement only, each |
| L8627 |
Cid ext speech process repl |
Cochlear implant, external speech processor, component, replacement |
| L8628 |
Cid ext controller repl |
Cochlear implant, external controller component, replacement |
| L8629 |
Cid transmit coil and cable |
Transmitting coil and cable, integrated, for use with cochlear implant device, replacement |
| L8630 |
Metacarpophalangeal implant |
Metacarpophalangeal joint implant |
| L8631 |
Mcp joint repl 2 pc or more |
Metacarpal phalangeal joint replacement, two or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon), for surgical implantation (all sizes, includes entire system) |
| L8641 |
Metatarsal joint implant |
Metatarsal joint implant |
| L8642 |
Hallux implant |
Hallux implant |
| L8658 |
Interphalangeal joint spacer |
Interphalangeal joint spacer, silicone or equal, each |
| L8659 |
Interphalangeal joint repl |
Interphalangeal finger joint replacement, 2 or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon) for surgical implantation, any size |
| L8670 |
Vascular graft, synthetic |
Vascular graft material, synthetic, implant |
| L8678 |
Ext sply implt neurostim |
Electrical stimulator supplies (external) for use with implantable neurostimulator, per month |
| L8679 |
Imp neurosti pls gn any type |
Implantable neurostimulator, pulse generator, any type |
| L8680 |
Implt neurostim elctr each |
Implantable neurostimulator electrode, each |
| L8681 |
Pt prgrm for implt neurostim |
Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only |
| L8682 |
Implt neurostim radiofq rec |
Implantable neurostimulator radiofrequency receiver |
| L8683 |
Radiofq trsmtr for implt neu |
Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver |
| L8684 |
Radiof trsmtr implt scrl neu |
Radiofrequency transmitter (external) for use with implantable sacral root neurostimulator receiver for bowel and bladder management, replacement |
| L8685 |
Implt nrostm pls gen sng rec |
Implantable neurostimulator pulse generator, single array, rechargeable, includes extension |
| L8686 |
Implt nrostm pls gen sng non |
Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension |
| L8687 |
Implt nrostm pls gen dua rec |
Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension |
| L8688 |
Implt nrostm pls gen dua non |
Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension |
| L8689 |
External recharg sys intern |
External recharging system for battery (internal) for use with implantable neurostimulator, replacement only |
| L8690 |
Aud osseo dev, int/ext comp |
Auditory osseointegrated device, includes all internal and external components |
| L8691 |
Aoi snd proc repl excl actua |
Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each |
| L8692 |
Non-osseointegrated snd proc |
Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment |
| L8693 |
Aud osseo dev, abutment |
Auditory osseointegrated device abutment, any length, replacement only |
| L8694 |
Aoi transducer/actuator repl |
Auditory osseointegrated device, transducer/actuator, replacement only, each |
| L8695 |
External recharg sys extern |
External recharging system for battery (external) for use with implantable neurostimulator, replacement only |
| L8696 |
Ext antenna phren nerve stim |
Antenna (external) for use with implantable diaphragmatic/phrenic nerve stimulation device, replacement, each |
| L8698 |
Misc used with tot art heart |
Miscellaneous component, supply or accessory for use with total artificial heart system |
| L8699 |
Prosthetic implant nos |
Prosthetic implant, not otherwise specified |
| L8701 |
Ewh s/d uprt micro sensor |
Powered 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 |
| L8702 |
Ewhf s/d uprt micro sensor |
Powered 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 |
| L9900 |
O&p supply/accessory/service |
Orthotic and prosthetic supply, accessory, and/or service component of another hcpcs l code |
| LC |
Lft circum coronary artery |
Left circumflex coronary artery |
| LD |
Left ant des coronary artery |
Left anterior descending coronary artery |
| LL |
Lease/rental (appld to pur) |
Lease/rental (use the 'll' modifier when dme equipment rental is to be applied against the purchase price) |
| LM |
Left main coronary artery |
Left main coronary artery |
| LR |
Laboratory round trip |
Laboratory round trip |
| LS |
Fda-monitored iol implant |
Fda-monitored intraocular lens implant |
| LT |
Left side |
Left side (used to identify procedures performed on the left side of the body) |
| LU |
Fractionated payment |
Fractionated payment |
