List of HCPCS codes for: Orthotic/Prosthetic Procedures (L-codes) - Group L4

HCPCS Code	Short Description	Long Description
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