| L3961 | Shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| L3962 | Shoulder elbow wrist hand orthosis, abduction positioning, erb's palsey design, prefabricated, includes fitting and adjustment |
| L3967 | 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 | 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 | 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 | Shoulder elbow wrist hand finger orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| L3976 | 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 | 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 | 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 | Upper extremity fracture orthosis, humeral, prefabricated, includes fitting and adjustment |
| L3981 | 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 extremity fracture orthosis, radius/ulnar, prefabricated, includes fitting and adjustment |
| L3984 | Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment |
| L3995 | Addition to upper extremity orthosis, sock, fracture or equal, each |
| L3999 | Upper limb orthosis, not otherwise specified |
| L4000 | Replace girdle for spinal orthosis (ctlso or so) |
| L4002 | Replacement strap, any orthosis, includes all components, any length, any type |
| L4010 | Replace trilateral socket brim |
| L4020 | Replace quadrilateral socket brim, molded to patient model |
| L4030 | Replace quadrilateral socket brim, custom fitted |
| L4040 | Replace molded thigh lacer, for custom fabricated orthosis only |
| L4045 | Replace non-molded thigh lacer, for custom fabricated orthosis only |
| L4050 | Replace molded calf lacer, for custom fabricated orthosis only |
| L4055 | Replace non-molded calf lacer, for custom fabricated orthosis only |
| L4060 | Replace high roll cuff |
| L4070 | Replace proximal and distal upright for kafo |
| L4080 | Replace metal bands kafo, proximal thigh |
| L4090 | Replace metal bands kafo-afo, calf or distal thigh |
| L4100 | Replace leather cuff kafo, proximal thigh |
| L4110 | Replace leather cuff kafo-afo, calf or distal thigh |
| L4130 | Replace pretibial shell |
| L4205 | Repair of orthotic device, labor component, per 15 minutes |
| L4210 | Repair of orthotic device, repair or replace minor parts |
| L4350 | Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
| L4360 | 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 | Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
| L4370 | Pneumatic full leg splint, prefabricated, off-the-shelf |
| L4386 | 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 | Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
| L4392 | Replacement, soft interface material, static afo |
| L4394 | Replace soft interface material, foot drop splint |
| L4396 | 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 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, recumbent positioning device, prefabricated, off-the-shelf |
| L4631 | 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 | Partial foot, shoe insert with longitudinal arch, toe filler |
| L5010 | Partial foot, molded socket, ankle height, with toe filler |
| L5020 | Partial foot, molded socket, tibial tubercle height, with toe filler |
| L5050 | Ankle, symes, molded socket, sach foot |
| L5060 | Ankle, symes, metal frame, molded leather socket, articulated ankle/foot |
| L5100 | Below knee, molded socket, shin, sach foot |
| L5105 | Below knee, plastic socket, joints and thigh lacer, sach foot |
| L5150 | Knee disarticulation (or through knee), molded socket, external knee joints, shin, sach foot |
| L5160 | Knee disarticulation (or through knee), molded socket, bent knee configuration, external knee joints, shin, sach foot |
| L5200 | Above knee, molded socket, single axis constant friction knee, shin, sach foot |
| L5210 | Above knee, short prosthesis, no knee joint ('stubbies'), with foot blocks, no ankle joints, each |
| L5220 | Above knee, short prosthesis, no knee joint ('stubbies'), with articulated ankle/foot, dynamically aligned, each |
| L5230 | Above knee, for proximal femoral focal deficiency, constant friction knee, shin, sach foot |
| L5250 | Hip disarticulation, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot |
| L5270 | Hip disarticulation, tilt table type; molded socket, locking hip joint, single axis constant friction knee, shin, sach foot |
| L5280 | Hemipelvectomy, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot |
| L5301 | Below knee, molded socket, shin, sach foot, endoskeletal system |
| L5312 | Knee disarticulation (or through knee), molded socket, single axis knee, pylon, sach foot, endoskeletal system |
| L5321 | Above knee, molded socket, open end, sach foot, endoskeletal system, single axis knee |
| L5331 | Hip disarticulation, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot |
| L5341 | Hemipelvectomy, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot |
| L5400 | Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment, suspension, and one cast change, below knee |
| L5410 | 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 | 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 | 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 | Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, below knee |
| L5460 | Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, above knee |
| L5500 | Initial, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed |
| L5505 | Initial, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed |
| L5510 | Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model |
| L5520 | Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed |
| L5530 | Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model |
| L5535 | Preparatory, below knee 'ptb' type socket, non-alignable system, no cover, sach foot, prefabricated, adjustable open end socket |
| L5540 | Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, laminated socket, molded to model |
| L5560 | Preparatory, above knee- knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model |
| L5570 | Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed |
| L5580 | Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model |
| L5585 | Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, prefabricated adjustable open end socket |
| L5590 | Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon no cover, sach foot, laminated socket, molded to model |
| L5595 | Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, thermoplastic or equal, molded to patient model |
| L5600 | Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, laminated socket, molded to patient model |
| L5610 | Addition to lower extremity, endoskeletal system, above knee, hydracadence system |
| L5611 | Addition to lower extremity, endoskeletal system, above knee - knee disarticulation, 4 bar linkage, with friction swing phase control |
| L5613 | Addition to lower extremity, endoskeletal system, above knee-knee disarticulation, 4 bar linkage, with hydraulic swing phase control |
| L5614 | Addition to lower extremity, exoskeletal system, above knee-knee disarticulation, 4 bar linkage, with pneumatic swing phase control |
| L5616 | Addition to lower extremity, endoskeletal system, above knee, universal multiplex system, friction swing phase control |
| L5617 | Addition to lower extremity, quick change self-aligning unit, above knee or below knee, each |
| L5618 | Addition to lower extremity, test socket, symes |
| L5620 | Addition to lower extremity, test socket, below knee |
| L5622 | Addition to lower extremity, test socket, knee disarticulation |
| L5624 | Addition to lower extremity, test socket, above knee |
| L5626 | Addition to lower extremity, test socket, hip disarticulation |
| L5628 | Addition to lower extremity, test socket, hemipelvectomy |
| L5629 | Addition to lower extremity, below knee, acrylic socket |
| L5630 | Addition to lower extremity, symes type, expandable wall socket |
| L5631 | Addition to lower extremity, above knee or knee disarticulation, acrylic socket |
| L5632 | Addition to lower extremity, symes type, 'ptb' brim design socket |
| L5634 | Addition to lower extremity, symes type, posterior opening (canadian) socket |
| L5636 | Addition to lower extremity, symes type, medial opening socket |
| L5637 | Addition to lower extremity, below knee, total contact |
| L5638 | Addition to lower extremity, below knee, leather socket |
| L5639 | Addition to lower extremity, below knee, wood socket |
| L5640 | Addition to lower extremity, knee disarticulation, leather socket |
| L5642 | Addition to lower extremity, above knee, leather socket |
| L5643 | Addition to lower extremity, hip disarticulation, flexible inner socket, external frame |
| L5644 | Addition to lower extremity, above knee, wood socket |
| L5645 | Addition to lower extremity, below knee, flexible inner socket, external frame |
| L5646 | Addition to lower extremity, below knee, air, fluid, gel or equal, cushion socket |
| L5647 | Addition to lower extremity, below knee suction socket |
| L5648 | Addition to lower extremity, above knee, air, fluid, gel or equal, cushion socket |
| L5649 | Addition to lower extremity, ischial containment/narrow m-l socket |
| L5650 | Additions to lower extremity, total contact, above knee or knee disarticulation socket |
| L5651 | Addition to lower extremity, above knee, flexible inner socket, external frame |
| L5652 | Addition to lower extremity, suction suspension, above knee or knee disarticulation socket |
| L5653 | Addition to lower extremity, knee disarticulation, expandable wall socket |
| L5654 | Addition to lower extremity, socket insert, symes, (kemblo, pelite, aliplast, plastazote or equal) |
| L5655 | Addition to lower extremity, socket insert, below knee (kemblo, pelite, aliplast, plastazote or equal) |
| L5656 | Addition to lower extremity, socket insert, knee disarticulation (kemblo, pelite, aliplast, plastazote or equal) |
| L5658 | Addition to lower extremity, socket insert, above knee (kemblo, pelite, aliplast, plastazote or equal) |
| L5661 | Addition to lower extremity, socket insert, multi-durometer symes |
| L5665 | Addition to lower extremity, socket insert, multi-durometer, below knee |
| L5666 | Addition to lower extremity, below knee, cuff suspension |
| L5668 | Addition to lower extremity, below knee, molded distal cushion |
| L5670 | Addition to lower extremity, below knee, molded supracondylar suspension ('pts' or similar) |
| L5671 | Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert |
| L5672 | Addition to lower extremity, below knee, removable medial brim suspension |
| L5673 | 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 | Additions to lower extremity, below knee, knee joints, single axis, pair |
| L5677 | Additions to lower extremity, below knee, knee joints, polycentric, pair |
| L5678 | Additions to lower extremity, below knee, joint covers, pair |
| L5679 | 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 | Addition to lower extremity, below knee, thigh lacer, nonmolded |
| L5681 | 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 | Addition to lower extremity, below knee, thigh lacer, gluteal/ischial, molded |
| L5683 | 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 | Addition to lower extremity, below knee, fork strap |
| L5685 | Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each |
| L5686 | Addition to lower extremity, below knee, back check (extension control) |
| L5688 | Addition to lower extremity, below knee, waist belt, webbing |
| L5690 | Addition to lower extremity, below knee, waist belt, padded and lined |
| L5692 | Addition to lower extremity, above knee, pelvic control belt, light |
| L5694 | Addition to lower extremity, above knee, pelvic control belt, padded and lined |
| L5695 | Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each |
| L5696 | Addition to lower extremity, above knee or knee disarticulation, pelvic joint |
| L5697 | Addition to lower extremity, above knee or knee disarticulation, pelvic band |
| L5698 | Addition to lower extremity, above knee or knee disarticulation, silesian bandage |
| L5699 | All lower extremity prostheses, shoulder harness |
| L5700 | Replacement, socket, below knee, molded to patient model |
| L5701 | Replacement, socket, above knee/knee disarticulation, including attachment plate, molded to patient model |
| L5702 | Replacement, socket, hip disarticulation, including hip joint, molded to patient model |
| L5703 | Ankle, symes, molded to patient model, socket without solid ankle cushion heel (sach) foot, replacement only |
| L5704 | Custom shaped protective cover, below knee |
| L5705 | Custom shaped protective cover, above knee |
| L5706 | Custom shaped protective cover, knee disarticulation |
| L5707 | Custom shaped protective cover, hip disarticulation |
| L5710 | Addition, exoskeletal knee-shin system, single axis, manual lock |
| L5711 | Additions exoskeletal knee-shin system, single axis, manual lock, ultra-light material |
| L5712 | Addition, exoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee) |
| L5714 | Addition, exoskeletal knee-shin system, single axis, variable friction swing phase control |
| L5716 | Addition, exoskeletal knee-shin system, polycentric, mechanical stance phase lock |
| L5718 | Addition, exoskeletal knee-shin system, polycentric, friction swing and stance phase control |
| L5722 | Addition, exoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control |
| L5724 | Addition, exoskeletal knee-shin system, single axis, fluid swing phase control |
| L5726 | Addition, exoskeletal knee-shin system, single axis, external joints fluid swing phase control |
| L5728 | Addition, exoskeletal knee-shin system, single axis, fluid swing and stance phase control |
| L5780 | Addition, exoskeletal knee-shin system, single axis, pneumatic/hydra pneumatic swing phase control |
| L5781 | Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system |
| L5782 | Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy duty |
| L5785 | Addition, exoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) |
| L5790 | Addition, exoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal) |
| L5795 | Addition, exoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal) |
| L5810 | Addition, endoskeletal knee-shin system, single axis, manual lock |
| L5811 | Addition, endoskeletal knee-shin system, single axis, manual lock, ultra-light material |
| L5812 | Addition, endoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee) |
| L5814 | Addition, endoskeletal knee-shin system, polycentric, hydraulic swing phase control, mechanical stance phase lock |
| L5816 | Addition, endoskeletal knee-shin system, polycentric, mechanical stance phase lock |
| L5818 | Addition, endoskeletal knee-shin system, polycentric, friction swing, and stance phase control |
| L5822 | Addition, endoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control |
| L5824 | Addition, endoskeletal knee-shin system, single axis, fluid swing phase control |
| L5826 | Addition, endoskeletal knee-shin system, single axis, hydraulic swing phase control, with miniature high activity frame |
| L5828 | Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control |
| L5830 | Addition, endoskeletal knee-shin system, single axis, pneumatic/ swing phase control |
| L5840 | Addition, endoskeletal knee/shin system, 4-bar linkage or multiaxial, pneumatic swing phase control |
| L5845 | Addition, endoskeletal, knee-shin system, stance flexion feature, adjustable |
| L5848 | Addition to endoskeletal knee-shin system, fluid stance extension, dampening feature, with or without adjustability |
| L5850 | Addition, endoskeletal system, above knee or hip disarticulation, knee extension assist |
| L5855 | Addition, endoskeletal system, hip disarticulation, mechanical hip extension assist |
| L5856 | Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type |
| L5857 | Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type |
| L5858 | Addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type |
| L5859 | Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s) |
| L5910 | Addition, endoskeletal system, below knee, alignable system |
| L5920 | Addition, endoskeletal system, above knee or hip disarticulation, alignable system |
| L5925 | Addition, endoskeletal system, above knee, knee disarticulation or hip disarticulation, manual lock |
| L5930 | Addition, endoskeletal system, high activity knee control frame |
| L5940 | Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) |
| L5950 | Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal) |
| L5960 | Addition, endoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal) |
| L5961 | Addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion and/or extension control |
| L5962 | Addition, endoskeletal system, below knee, flexible protective outer surface covering system |
| L5964 | Addition, endoskeletal system, above knee, flexible protective outer surface covering system |
| L5966 | Addition, endoskeletal system, hip disarticulation, flexible protective outer surface covering system |
| L5968 | Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature |
| L5969 | Addition, endoskeletal ankle-foot or ankle system, power assist, includes any type motor(s) |
| L5970 | All lower extremity prostheses, foot, external keel, sach foot |
| L5971 | All lower extremity prosthesis, solid ankle cushion heel (sach) foot, replacement only |
| L5972 | All lower extremity prostheses, foot, flexible keel |
| L5973 | Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source |
| L5974 | All lower extremity prostheses, foot, single axis ankle/foot |
| L5975 | All lower extremity prosthesis, combination single axis ankle and flexible keel foot |
| L5976 | All lower extremity prostheses, energy storing foot (seattle carbon copy ii or equal) |
| L5978 | All lower extremity prostheses, foot, multiaxial ankle/foot |
| L5979 | All lower extremity prosthesis, multi-axial ankle, dynamic response foot, one piece system |
| L5980 | All lower extremity prostheses, flex foot system |
| L5981 | All lower extremity prostheses, flex-walk system or equal |
| L5982 | All exoskeletal lower extremity prostheses, axial rotation unit |
| L5984 | All endoskeletal lower extremity prosthesis, axial rotation unit, with or without adjustability |
| L5985 | All endoskeletal lower extremity prostheses, dynamic prosthetic pylon |
| L5986 | All lower extremity prostheses, multi-axial rotation unit ('mcp' or equal) |
| L5987 | All lower extremity prosthesis, shank foot system with vertical loading pylon |
| L5988 | Addition to lower limb prosthesis, vertical shock reducing pylon feature |
| L5990 | Addition to lower extremity prosthesis, user adjustable heel height |
| L5999 | Lower extremity prosthesis, not otherwise specified |
| L6000 | Partial hand, thumb remaining |
| L6010 | Partial hand, little and/or ring finger remaining |
| L6020 | Partial hand, no finger remaining |
| L6025 | 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 | 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 | Wrist disarticulation, molded socket, flexible elbow hinges, triceps pad |
| L6055 | Wrist disarticulation, molded socket with expandable interface, flexible elbow hinges, triceps pad |
| L6100 | Below elbow, molded socket, flexible elbow hinge, triceps pad |
| L6110 | Below elbow, molded socket, (muenster or northwestern suspension types) |
| L6120 | Below elbow, molded double wall split socket, step-up hinges, half cuff |
| L6130 | Below elbow, molded double wall split socket, stump activated locking hinge, half cuff |
| L6200 | Elbow disarticulation, molded socket, outside locking hinge, forearm |
| L6205 | Elbow disarticulation, molded socket with expandable interface, outside locking hinges, forearm |
| L6250 | Above elbow, molded double wall socket, internal locking elbow, forearm |
| L6300 | Shoulder disarticulation, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm |
| L6310 | Shoulder disarticulation, passive restoration (complete prosthesis) |
| L6320 | Shoulder disarticulation, passive restoration (shoulder cap only) |
| L6350 | Interscapular thoracic, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm |
| L6360 | Interscapular thoracic, passive restoration (complete prosthesis) |
| L6370 | Interscapular thoracic, passive restoration (shoulder cap only) |
| L6380 | 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 | 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 | 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 | Immediate post surgical or early fitting, each additional cast change and realignment |
| L6388 | Immediate post surgical or early fitting, application of rigid dressing only |
| L6400 | Below elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping |
| L6450 | Elbow disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping |
| L6500 | Above elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping |
| L6550 | Shoulder disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping |
| L6570 | Interscapular thoracic, molded socket, endoskeletal system, including soft prosthetic tissue shaping |
| L6580 | 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 | 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 | 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 | 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 | 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 | 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 | Upper extremity additions, polycentric hinge, pair |
| L6605 | Upper extremity additions, single pivot hinge, pair |
| L6610 | Upper extremity additions, flexible metal hinge, pair |
| L6611 | Addition to upper extremity prosthesis, external powered, additional switch, any type |
| L6615 | Upper extremity addition, disconnect locking wrist unit |
| L6616 | Upper extremity addition, additional disconnect insert for locking wrist unit, each |
| L6620 | Upper extremity addition, flexion/extension wrist unit, with or without friction |
| L6621 | Upper extremity prosthesis addition, flexion/extension wrist with or without friction, for use with external powered terminal device |
| L6623 | Upper extremity addition, spring assisted rotational wrist unit with latch release |
| L6624 | Upper extremity addition, flexion/extension and rotation wrist unit |
| L6625 | Upper extremity addition, rotation wrist unit with cable lock |
| L6628 | Upper extremity addition, quick disconnect hook adapter, otto bock or equal |
| L6629 | Upper extremity addition, quick disconnect lamination collar with coupling piece, otto bock or equal |
| L6630 | Upper extremity addition, stainless steel, any wrist |
| L6632 | Upper extremity addition, latex suspension sleeve, each |
| L6635 | Upper extremity addition, lift assist for elbow |
| L6637 | Upper extremity addition, nudge control elbow lock |
| L6638 | Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow |
| L6640 | Upper extremity additions, shoulder abduction joint, pair |
| L6641 | Upper extremity addition, excursion amplifier, pulley type |
| L6642 | Upper extremity addition, excursion amplifier, lever type |
| L6645 | Upper extremity addition, shoulder flexion-abduction joint, each |
| L6646 | Upper extremity addition, shoulder joint, multipositional locking, flexion, adjustable abduction friction control, for use with body powered or external powered system |
| L6647 | Upper extremity addition, shoulder lock mechanism, body powered actuator |
| L6648 | Upper extremity addition, shoulder lock mechanism, external powered actuator |
| L6650 | Upper extremity addition, shoulder universal joint, each |
| L6655 | Upper extremity addition, standard control cable, extra |
| L6660 | Upper extremity addition, heavy duty control cable |
| L6665 | Upper extremity addition, teflon, or equal, cable lining |
| L6670 | Upper extremity addition, hook to hand, cable adapter |
| L6672 | Upper extremity addition, harness, chest or shoulder, saddle type |
| L6675 | Upper extremity addition, harness, (e.g., figure of eight type), single cable design |
| L6676 | Upper extremity addition, harness, (e.g., figure of eight type), dual cable design |
| L6677 | Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow |
| L6680 | Upper extremity addition, test socket, wrist disarticulation or below elbow |
| L6682 | Upper extremity addition, test socket, elbow disarticulation or above elbow |
| L6684 | Upper extremity addition, test socket, shoulder disarticulation or interscapular thoracic |
| L6686 | Upper extremity addition, suction socket |
| L6687 | Upper extremity addition, frame type socket, below elbow or wrist disarticulation |
| L6688 | Upper extremity addition, frame type socket, above elbow or elbow disarticulation |
| L6689 | Upper extremity addition, frame type socket, shoulder disarticulation |
| L6690 | Upper extremity addition, frame type socket, interscapular-thoracic |
| L6691 | Upper extremity addition, removable insert, each |
| L6692 | Upper extremity addition, silicone gel insert or equal, each |
| L6693 | Upper extremity addition, locking elbow, forearm counterbalance |
| L6694 | 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 | 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 | 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 | 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 | Addition to upper extremity prosthesis, below elbow/above elbow, lock mechanism, excludes socket insert |
| L6703 | Terminal device, passive hand/mitt, any material, any size |
| L6704 | Terminal device, sport/recreational/work attachment, any material, any size |
| L6706 | Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined |
| L6707 | Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined |
| L6708 | Terminal device, hand, mechanical, voluntary opening, any material, any size |
| L6709 | Terminal device, hand, mechanical, voluntary closing, any material, any size |
| L6711 | Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined, pediatric |
| L6712 | Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined, pediatric |
| L6713 | Terminal device, hand, mechanical, voluntary opening, any material, any size, pediatric |
| L6714 | Terminal device, hand, mechanical, voluntary closing, any material, any size, pediatric |
| L6715 | Terminal device, multiple articulating digit, includes motor(s), initial issue or replacement |
| L6721 | Terminal device, hook or hand, heavy duty, mechanical, voluntary opening, any material, any size, lined or unlined |
| L6722 | Terminal device, hook or hand, heavy duty, mechanical, voluntary closing, any material, any size, lined or unlined |
| L6805 | Addition to terminal device, modifier wrist unit |
| L6810 | Addition to terminal device, precision pinch device |
| L6880 | Electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s) |
| L6881 | Automatic grasp feature, addition to upper limb electric prosthetic terminal device |
| L6882 | Microprocessor control feature, addition to upper limb prosthetic terminal device |
| L6883 | Replacement socket, below elbow/wrist disarticulation, molded to patient model, for use with or without external power |
| L6884 | Replacement socket, above elbow/elbow disarticulation, molded to patient model, for use with or without external power |
| L6885 | Replacement socket, shoulder disarticulation/interscapular thoracic, molded to patient model, for use with or without external power |
| L6890 | Addition to upper extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment |
| L6895 | Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated |
| L6900 | Hand restoration (casts, shading and measurements included), partial hand, with glove, thumb or one finger remaining |
| L6905 | Hand restoration (casts, shading and measurements included), partial hand, with glove, multiple fingers remaining |
| L6910 | Hand restoration (casts, shading and measurements included), partial hand, with glove, no fingers remaining |
| L6915 | Hand restoration (shading, and measurements included), replacement glove for above |
| L6920 | 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 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, 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, 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, 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 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, 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, 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 | 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 | 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-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 | 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 | Electric hand, switch or myoelectric controlled, adult |
| L7008 | Electric hand, switch or myoelectric, controlled, pediatric |
| L7009 | Electric hook, switch or myoelectric controlled, adult |
| L7040 | Prehensile actuator, switch controlled |
| L7045 | Electric hook, switch or myoelectric controlled, pediatric |
| L7170 | Electronic elbow, hosmer or equal, switch controlled |
| L7180 | Electronic elbow, microprocessor sequential control of elbow and terminal device |
| L7181 | Electronic elbow, microprocessor simultaneous control of elbow and terminal device |
| L7185 | Electronic elbow, adolescent, variety village or equal, switch controlled |
| L7186 | Electronic elbow, child, variety village or equal, switch controlled |
| L7190 | Electronic elbow, adolescent, variety village or equal, myoelectronically controlled |
| L7191 | Electronic elbow, child, variety village or equal, myoelectronically controlled |
| L7259 | Electronic wrist rotator, any type |
| L7260 | Electronic wrist rotator, otto bock or equal |
| L7261 | Electronic wrist rotator, for utah arm |
| L7360 | Six volt battery, each |
| L7362 | Battery charger, six volt, each |
| L7364 | Twelve volt battery, each |
| L7366 | Battery charger, twelve volt, each |
| L7367 | Lithium ion battery, rechargeable, replacement |
| L7368 | Lithium ion battery charger, replacement only |
| L7400 | Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultralight material (titanium, carbon fiber or equal) |
| L7401 | Addition to upper extremity prosthesis, above elbow disarticulation, ultralight material (titanium, carbon fiber or equal) |
| L7402 | Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultralight material (titanium, carbon fiber or equal) |
| L7403 | Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material |
| L7404 | Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material |
| L7405 | Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material |
| L7499 | Upper extremity prosthesis, not otherwise specified |
| L7510 | Repair of prosthetic device, repair or replace minor parts |
| L7520 | Repair prosthetic device, labor component, per 15 minutes |
| L7600 | Prosthetic donning sleeve, any material, each |
| L7700 | Gasket or seal, for use with prosthetic socket insert, any type, each |
| L7900 | Male vacuum erection system |
| L7902 | Tension ring, for vacuum erection device, any type, replacement only, each |
| L8000 | Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
| L8001 | Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type |
| L8002 | Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type |
| L8010 | Breast prosthesis, mastectomy sleeve |
| L8015 | External breast prosthesis garment, with mastectomy form, post mastectomy |
| L8020 | Breast prosthesis, mastectomy form |
| L8030 | Breast prosthesis, silicone or equal, without integral adhesive |
| L8031 | Breast prosthesis, silicone or equal, with integral adhesive |
| L8032 | Nipple prosthesis, prefabricated, reusable, any type, each |
| L8033 | Nipple prosthesis, custom fabricated, reusable, any material, any type, each |
| L8035 | Custom breast prosthesis, post mastectomy, molded to patient model |
| L8039 | Breast prosthesis, not otherwise specified |
| L8040 | Nasal prosthesis, provided by a non-physician |
| L8041 | Midfacial prosthesis, provided by a non-physician |
| L8042 | Orbital prosthesis, provided by a non-physician |
| L8043 | Upper facial prosthesis, provided by a non-physician |
| L8044 | Hemi-facial prosthesis, provided by a non-physician |
| L8045 | Auricular prosthesis, provided by a non-physician |
| L8046 | Partial facial prosthesis, provided by a non-physician |
| L8047 | Nasal septal prosthesis, provided by a non-physician |
| L8048 | Unspecified maxillofacial prosthesis, by report, provided by a non-physician |
| L8049 | Repair or modification of maxillofacial prosthesis, labor component, 15 minute increments, provided by a non-physician |
| L8300 | Truss, single with standard pad |
| L8310 | Truss, double with standard pads |
| L8320 | Truss, addition to standard pad, water pad |
| L8330 | Truss, addition to standard pad, scrotal pad |
| L8400 | Prosthetic sheath, below knee, each |
| L8410 | Prosthetic sheath, above knee, each |
| L8415 | Prosthetic sheath, upper limb, each |
| L8417 | Prosthetic sheath/sock, including a gel cushion layer, below knee or above knee, each |
| L8420 | Prosthetic sock, multiple ply, below knee, each |
| L8430 | Prosthetic sock, multiple ply, above knee, each |
| L8435 | Prosthetic sock, multiple ply, upper limb, each |
| L8440 | Prosthetic shrinker, below knee, each |
| L8460 | Prosthetic shrinker, above knee, each |
| L8465 | Prosthetic shrinker, upper limb, each |
| L8470 | Prosthetic sock, single ply, fitting, below knee, each |
| L8480 | Prosthetic sock, single ply, fitting, above knee, each |
| L8485 | Prosthetic sock, single ply, fitting, upper limb, each |
| L8499 | Unlisted procedure for miscellaneous prosthetic services |
| L8500 | Artificial larynx, any type |
| L8501 | Tracheostomy speaking valve |
| L8505 | Artificial larynx replacement battery / accessory, any type |
| L8507 | Tracheo-esophageal voice prosthesis, patient inserted, any type, each |
| L8509 | Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type |
| L8510 | Voice amplifier |
| L8511 | Insert for indwelling tracheoesophageal prosthesis, with or without valve, replacement only, each |
| L8512 | Gelatin capsules or equivalent, for use with tracheoesophageal voice prosthesis, replacement only, per 10 |
| L8513 | Cleaning device used with tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each |
| L8514 | Tracheoesophageal puncture dilator, replacement only, each |
| L8515 | Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each |
| L8600 | Implantable breast prosthesis, silicone or equal |
| L8603 | Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies |
| L8604 | Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, urinary tract, 1 ml, includes shipping and necessary supplies |
| L8605 | Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, anal canal, 1 ml, includes shipping and necessary supplies |
| L8606 | Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe, includes shipping and necessary supplies |
| L8607 | Injectable bulking agent for vocal cord medialization, 0.1 ml, includes shipping and necessary supplies |
| L8608 | Miscellaneous external component, supply or accessory for use with the argus ii retinal prosthesis system |
| L8609 | Artificial cornea |
| L8610 | Ocular implant |
| L8612 | Aqueous shunt |
| L8613 | Ossicula implant |
| L8614 | Cochlear device, includes all internal and external components |
| L8615 | Headset/headpiece for use with cochlear implant device, replacement |
| L8616 | Microphone for use with cochlear implant device, replacement |
| L8617 | Transmitting coil for use with cochlear implant device, replacement |
| L8618 | Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement |
| L8619 | Cochlear implant, external speech processor and controller, integrated system, replacement |
| L8621 | Zinc air battery for use with cochlear implant device and auditory osseointegrated sound processors, replacement, each |
| L8622 | Alkaline battery for use with cochlear implant device, any size, replacement, each |
| L8623 | Lithium ion battery for use with cochlear implant device speech processor, other than ear level, replacement, each |
| L8624 | Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement, each |
| L8625 | External recharging system for battery for use with cochlear implant or auditory osseointegrated device, replacement only, each |
| L8627 | Cochlear implant, external speech processor, component, replacement |
| L8628 | Cochlear implant, external controller component, replacement |
| L8629 | Transmitting coil and cable, integrated, for use with cochlear implant device, replacement |
| L8630 | Metacarpophalangeal joint implant |
| L8631 | 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 |
| L8642 | Hallux implant |
| L8658 | Interphalangeal joint spacer, silicone or equal, each |
| L8659 | 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 material, synthetic, implant |
| L8678 | Electrical stimulator supplies (external) for use with implantable neurostimulator, per month |
| L8679 | Implantable neurostimulator, pulse generator, any type |
| L8680 | Implantable neurostimulator electrode, each |
| L8681 | Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only |
| L8682 | Implantable neurostimulator radiofrequency receiver |
| L8683 | Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver |
| L8684 | Radiofrequency transmitter (external) for use with implantable sacral root neurostimulator receiver for bowel and bladder management, replacement |
| L8685 | Implantable neurostimulator pulse generator, single array, rechargeable, includes extension |
| L8686 | Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension |
| L8687 | Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension |
| L8688 | Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension |
| L8689 | External recharging system for battery (internal) for use with implantable neurostimulator, replacement only |
| L8690 | Auditory osseointegrated device, includes all internal and external components |
| L8691 | Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each |
| L8692 | Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment |
| L8693 | Auditory osseointegrated device abutment, any length, replacement only |
| L8694 | Auditory osseointegrated device, transducer/actuator, replacement only, each |
| L8695 | External recharging system for battery (external) for use with implantable neurostimulator, replacement only |
| L8696 | Antenna (external) for use with implantable diaphragmatic/phrenic nerve stimulation device, replacement, each |
| L8698 | Miscellaneous component, supply or accessory for use with total artificial heart system |
| L8699 | Prosthetic implant, not otherwise specified |
| L8701 | 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 | 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 | Orthotic and prosthetic supply, accessory, and/or service component of another hcpcs "l" code |
| L0112 | Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated |
| L0113 | Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment |
| L0120 | Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar) |
| L0130 | Cervical, flexible, thermoplastic collar, molded to patient |
| L0140 | Cervical, semi-rigid, adjustable (plastic collar) |
| L0150 | Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibular/occipital piece) |
