HCPCS L codes

• 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)
• L0160 Cervical, semi-rigid, wire frame occipital/mandibular support, prefabricated, off-the-shelf
• L0170 Cervical, collar, molded to patient model
• L0172 Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf
• L0174 Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf
• L0180 Cervical, multiple post collar, occipital/mandibular supports, adjustable
• L0190 Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars (somi, guilford, taylor types)
• L0200 Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars, and thoracic extension
• L0220 Thoracic, rib belt, custom fabricated
• L0450 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, 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 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, 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, 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, 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, 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, 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, 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, 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, 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, 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, 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, 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, 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, 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, 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, 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, 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, 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, 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, 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, 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, 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 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 Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated
• L0623 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 Cervical-thoracic-lumbar-sacral-orthoses (ctlso), anterior-posterior-lateral control, molded to patient model, (minerva type)
• L0710 Ctlso, anterior-posterior-lateral-control, molded to patient model, with interface material, (minerva type)
• L0720 Cervical-thoracic-lumbar-sacral-orthoses (ctlso), anterior-posterior-lateral control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
• L0810 Halo procedure, cervical halo incorporated into jacket vest
• L0820 Halo procedure, cervical halo incorporated into plaster body jacket
• L0830 Halo procedure, cervical halo incorporated into milwaukee type orthosis
• L0859 Addition to halo procedure, magnetic resonance image compatible systems, rings and pins, any material
• L0861 Addition to halo procedure, replacement liner/interface material
• L0970 Tlso, corset front
• L0972 Lso, corset front
• L0974 Tlso, full corset
• L0976 Lso, full corset
• L0978 Axillary crutch extension
• L0980 Peroneal straps, prefabricated, off-the-shelf, pair
• L0982 Stocking supporter grips, prefabricated, off-the-shelf, set of four (4)
• L0984 Protective body sock, prefabricated, off-the-shelf, each
• L0999 Addition to spinal orthosis, not otherwise specified
• L1000 Cervical-thoracic-lumbar-sacral orthosis (ctlso) (milwaukee), inclusive of furnishing initial orthosis, including model
• L1001 Cervical thoracic lumbar sacral orthosis, immobilizer, infant size, prefabricated, includes fitting and adjustment
• L1005 Tension based scoliosis orthosis and accessory pads, includes fitting and adjustment
• L1006 Scoliosis orthosis, sagittal-coronal control provided by a rigid lateral frame, extends from axilla to trochanter, includes all accessory pads, straps and interface, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
• L1007 Scoliosis orthosis, sagittal-coronal control provided by a rigid lateral frame, extends from axilla, to trochanter, includes all accessory pads, straps, and interface, custom fabricated
• L1010 Addition to cervical-thoracic-lumbar-sacral orthosis (ctlso) or scoliosis orthosis, axilla sling
• L1020 Addition to ctlso or scoliosis orthosis, kyphosis pad
• L1025 Addition to ctlso or scoliosis orthosis, kyphosis pad, floating
• L1030 Addition to ctlso or scoliosis orthosis, lumbar bolster pad
• L1040 Addition to ctlso or scoliosis orthosis, lumbar or lumbar rib pad
• L1050 Addition to ctlso or scoliosis orthosis, sternal pad
• L1060 Addition to ctlso or scoliosis orthosis, thoracic pad
• L1070 Addition to ctlso or scoliosis orthosis, trapezius sling
• L1080 Addition to ctlso or scoliosis orthosis, outrigger
• L1085 Addition to ctlso or scoliosis orthosis, outrigger, bilateral with vertical extensions
• L1090 Addition to ctlso or scoliosis orthosis, lumbar sling
• L1100 Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather
• L1110 Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather, molded to patient model
• L1120 Addition to ctlso, scoliosis orthosis, cover for upright, each
• L1200 Thoracic-lumbar-sacral-orthosis (tlso), inclusive of furnishing initial orthosis only
• L1210 Addition to tlso, (low profile), lateral thoracic extension
• L1220 Addition to tlso, (low profile), anterior thoracic extension
• L1230 Addition to tlso, (low profile), milwaukee type superstructure
• L1240 Addition to tlso, (low profile), lumbar derotation pad
• L1250 Addition to tlso, (low profile), anterior asis pad
• L1260 Addition to tlso, (low profile), anterior thoracic derotation pad
• L1270 Addition to tlso, (low profile), abdominal pad
• L1280 Addition to tlso, (low profile), rib gusset (elastic), each
• L1290 Addition to tlso, (low profile), lateral trochanteric pad
• L1300 Other scoliosis procedure, body jacket molded to patient model
• L1310 Other scoliosis procedure, post-operative body jacket
• L1320 Thoracic, pectus carinatum orthosis, sternal compression, rigid circumferential frame with anterior and posterior rigid pads, custom fabricated
• L1499 Spinal orthosis, not otherwise specified
• L1600 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 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 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 Hip orthosis, abduction control of hip joints, semi-flexible (von rosen type), custom fabricated
• L1640 Hip orthosis, abduction control of hip joints, static, pelvic band or spreader bar, thigh cuffs, custom fabricated
• L1650 Hip orthosis, abduction control of hip joints, static, adjustable, (ilfled type), prefabricated, includes fitting and adjustment
• L1652 Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, includes fitting and adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
• L1653 Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, off the shelf
• L1660 Hip orthosis, abduction control of hip joints, static, plastic, prefabricated, includes fitting and adjustment
• L1680 Hip orthosis, abduction control of hip joints, dynamic, pelvic control, adjustable hip motion control, thigh cuffs (rancho hip action type), custom fabricated
• L1681 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 Hip orthosis, abduction control of hip joint, postoperative hip abduction type, custom fabricated
• L1686 Hip orthosis, abduction control of hip joint, postoperative hip abduction type, prefabricated, includes fitting and adjustment
• L1690 Combination, bilateral, lumbo-sacral, hip, femur orthosis providing adduction and internal rotation control, prefabricated, includes fitting and adjustment
• L1700 Legg perthes orthosis, (toronto type), custom fabricated
• L1710 Legg perthes orthosis, (newington type), custom fabricated
• L1720 Legg perthes orthosis, trilateral, (tachdijan type), custom fabricated
• L1730 Legg perthes orthosis, (scottish rite type), custom fabricated
• L1755 Legg perthes orthosis, (patten bottom type), custom fabricated
• L1810 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 Knee orthosis, elastic with joints, prefabricated, off-the-shelf
• L1820 Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
• L1821 Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, off the shelf
• L1830 Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf
• L1831 Knee orthosis, locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment
• L1832 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 Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf
• L1834 Knee orthosis, without knee joint, rigid, custom fabricated
• L1836 Knee orthosis, rigid, without joint(s), includes soft interface material, prefabricated, off-the-shelf
• L1840 Knee orthosis, derotation, medial-lateral, anterior cruciate ligament, custom fabricated
• L1843 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 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 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 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 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 Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated, off-the-shelf
• L1850 Knee orthosis, swedish type, prefabricated, off-the-shelf
• L1851 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 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 Knee orthosis, modification of supracondylar prosthetic socket, custom fabricated (sk)
• L1900 Ankle foot orthosis, spring wire, dorsiflexion assist calf band, custom fabricated
• L1902 Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf
• L1904 Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated
• L1906 Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf
• L1907 Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated
• L1910 Ankle foot orthosis, posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment
• L1920 Ankle foot orthosis, single upright with static or adjustable stop (phelps or perlstein type), custom fabricated
• L1930 Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment
• L1932 Ankle foot orthosis, rigid anterior tibial section, total carbon fiber or equal material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
• L1933 Ankle foot orthosis, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, off-the-shelf
• L1940 Ankle foot orthosis, plastic or other material, custom fabricated
• L1945 Ankle foot orthosis, plastic, rigid anterior tibial section (floor reaction), custom fabricated
• L1950 Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic, custom fabricated
• L1951 Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
• L1952 Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, off-the-shelf
• L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
• L1970 Ankle foot orthosis, plastic with ankle joint, custom fabricated
• L1971 Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment
• L1980 Ankle foot orthosis, single upright free plantar dorsiflexion, solid stirrup, calf band/cuff (single bar 'bk' orthosis), custom fabricated
• L1990 Ankle foot orthosis, double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar 'bk' orthosis), custom fabricated
• L2000 Knee ankle foot orthosis, single upright, free knee, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar 'ak' orthosis), custom fabricated
• L2005 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 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 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 Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs (double bar 'ak' orthosis), custom fabricated
• L2030 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 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 Knee ankle foot orthosis, full plastic, static (pediatric size), without free motion ankle, prefabricated, includes fitting and adjustment
• L2036 Knee ankle foot orthosis, full plastic, double upright, with or without free motion knee, with or without free motion ankle, custom fabricated
• L2037 Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, with or without free motion ankle, custom fabricated
• L2038 Knee ankle foot orthosis, full plastic, with or without free motion knee, multi-axis ankle, custom fabricated
• L2040 Hip knee ankle foot orthosis, torsion control, bilateral rotation straps, pelvic band/belt, custom fabricated
• L2050 Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, hip joint, pelvic band/belt, custom fabricated
• L2060 Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, ball bearing hip joint, pelvic band/ belt, custom fabricated
• L2070 Hip knee ankle foot orthosis, torsion control, unilateral rotation straps, pelvic band/belt, custom fabricated
• L2080 Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, hip joint, pelvic band/belt, custom fabricated
• L2090 Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, ball bearing hip joint, pelvic band/ belt, custom fabricated
• L2106 Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, thermoplastic type casting material, custom fabricated
• L2108 Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, custom fabricated
• L2112 Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment
• L2114 Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment
• L2116 Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, rigid, prefabricated, includes fitting and adjustment
• L2126 Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, thermoplastic type casting material, custom fabricated
• L2128 Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, custom fabricated
• L2132 Kafo, fracture orthosis, femoral fracture cast orthosis, soft, prefabricated, includes fitting and adjustment
• L2134 Kafo, fracture orthosis, femoral fracture cast orthosis, semi-rigid, prefabricated, includes fitting and adjustment
• L2136 Kafo, fracture orthosis, femoral fracture cast orthosis, rigid, prefabricated, includes fitting and adjustment
• L2180 Addition to lower extremity fracture orthosis, plastic shoe insert with ankle joints
• L2182 Addition to lower extremity fracture orthosis, drop lock knee joint
• L2184 Addition to lower extremity fracture orthosis, limited motion knee joint
• L2186 Addition to lower extremity fracture orthosis, adjustable motion knee joint, lerman type
• L2188 Addition to lower extremity fracture orthosis, quadrilateral brim
• L2190 Addition to lower extremity fracture orthosis, waist belt
• L2192 Addition to lower extremity fracture orthosis, hip joint, pelvic band, thigh flange, and pelvic belt
• L2200 Addition to lower extremity, limited ankle motion, each joint
• L2210 Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint
• L2220 Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint
• L2221 Addition to lower extremity orthosis, ankle system, microprocessor-controlled feature plantarflexion and/or dorsiflexion, includes power source
• L2230 Addition to lower extremity, split flat caliper stirrups and plate attachment
• L2232 Addition to lower extremity orthosis, rocker bottom for total contact ankle foot orthosis, for custom fabricated orthosis only
• L2240 Addition to lower extremity, round caliper and plate attachment
• L2250 Addition to lower extremity, foot plate, molded to patient model, stirrup attachment
• L2260 Addition to lower extremity, reinforced solid stirrup (scott-craig type)
• L2265 Addition to lower extremity, long tongue stirrup
• L2270 Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad
• L2275 Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined
• L2280 Addition to lower extremity, molded inner boot
• L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
• L2310 Addition to lower extremity, abduction bar-straight
• L2320 Addition to lower extremity, non-molded lacer, for custom fabricated orthosis only
• L2330 Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only
• L2335 Addition to lower extremity, anterior swing band
• L2340 Addition to lower extremity, pre-tibial shell, molded to patient model
• L2350 Addition to lower extremity, prosthetic type, (bk) socket, molded to patient model, (used for 'ptb' 'afo' orthoses)
• L2360 Addition to lower extremity, extended steel shank
• L2370 Addition to lower extremity, patten bottom
• L2375 Addition to lower extremity, torsion control, ankle joint and half solid stirrup
• L2380 Addition to lower extremity, torsion control, straight knee joint, each joint
• L2385 Addition to lower extremity, straight knee joint, heavy duty, each joint
• L2387 Addition to lower extremity, polycentric knee joint, for custom fabricated knee ankle foot orthosis, each joint
• L2390 Addition to lower extremity, offset knee joint, each joint
• L2395 Addition to lower extremity, offset knee joint, heavy duty, each joint
• L2397 Addition to lower extremity orthosis, suspension sleeve
• L2405 Addition to knee joint, drop lock, each
• L2415 Addition to knee lock with integrated release mechanism (bail, cable, or equal), any material, each joint
• L2425 Addition to knee joint, disc or dial lock for adjustable knee flexion, each joint
• L2430 Addition to knee joint, ratchet lock for active and progressive knee extension, each joint
• L2492 Addition to knee joint, lift loop for drop lock ring
• L2500 Addition to lower extremity, thigh/weight bearing, gluteal/ ischial weight bearing, ring
• L2510 Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, molded to patient model
• L2520 Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, custom fitted
• L2525 Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim molded to patient model
• L2526 Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim, custom fitted
• L2530 Addition to lower extremity, thigh-weight bearing, lacer, non-molded
• L2540 Addition to lower extremity, thigh/weight bearing, lacer, molded to patient model
• L2550 Addition to lower extremity, thigh/weight bearing, high roll cuff
• L2570 Addition to lower extremity, pelvic control, hip joint, clevis type two position joint, each
• L2580 Addition to lower extremity, pelvic control, pelvic sling
• L2600 Addition to lower extremity, pelvic control, hip joint, clevis type, or thrust bearing, free, each
• L2610 Addition to lower extremity, pelvic control, hip joint, clevis or thrust bearing, lock, each
• L2620 Addition to lower extremity, pelvic control, hip joint, heavy duty, each
• L2622 Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each
• L2624 Addition to lower extremity, pelvic control, hip joint, adjustable flexion, extension, abduction control, each
• L2627 Addition to lower extremity, pelvic control, plastic, molded to patient model, reciprocating hip joint and cables
• L2628 Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables
• L2630 Addition to lower extremity, pelvic control, band and belt, unilateral
• L2640 Addition to lower extremity, pelvic control, band and belt, bilateral
• L2650 Addition to lower extremity, pelvic and thoracic control, gluteal pad, each
• L2660 Addition to lower extremity, thoracic control, thoracic band
• L2670 Addition to lower extremity, thoracic control, paraspinal uprights
• L2680 Addition to lower extremity, thoracic control, lateral support uprights
• L2750 Addition to lower extremity orthosis, plating chrome or nickel, per bar
• L2755 Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only
• L2760 Addition to lower extremity orthosis, extension, per extension, per bar (for lineal adjustment for growth)
• L2768 Orthotic side bar disconnect device, per bar
• L2780 Addition to lower extremity orthosis, non-corrosive finish, per bar
• L2785 Addition to lower extremity orthosis, drop lock retainer, each
• L2795 Addition to lower extremity orthosis, knee control, full kneecap
• L2800 Addition to lower extremity orthosis, knee control, knee cap, medial or lateral pull, for use with custom fabricated orthosis only
• L2810 Addition to lower extremity orthosis, knee control, condylar pad
• L2820 Addition to lower extremity orthosis, soft interface for molded plastic, below knee section
• L2830 Addition to lower extremity orthosis, soft interface for molded plastic, above knee section
• L2840 Addition to lower extremity orthosis, tibial length sock, fracture or equal, each
• L2850 Addition to lower extremity orthosis, femoral length sock, fracture or equal, each
• L2861 Addition to lower extremity joint, knee or ankle, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each
• L2999 Lower extremity orthoses, not otherwise specified
• L3000 Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each
• L3001 Foot, insert, removable, molded to patient model, spenco, each
• L3002 Foot, insert, removable, molded to patient model, plastazote or equal, each
• L3003 Foot, insert, removable, molded to patient model, silicone gel, each
• L3010 Foot, insert, removable, molded to patient model, longitudinal arch support, each
• L3020 Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each
• L3030 Foot, insert, removable, formed to patient foot, each
• L3031 Foot, insert/plate, removable, addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, each
• L3040 Foot, arch support, removable, premolded, longitudinal, each
• L3050 Foot, arch support, removable, premolded, metatarsal, each
• L3060 Foot, arch support, removable, premolded, longitudinal/ metatarsal, each
• L3070 Foot, arch support, non-removable attached to shoe, longitudinal, each
• L3080 Foot, arch support, non-removable attached to shoe, metatarsal, each
• L3090 Foot, arch support, non-removable attached to shoe, longitudinal/metatarsal, each
• L3100 Hallus-valgus night dynamic splint, prefabricated, off-the-shelf
• L3140 Foot, abduction rotation bar, including shoes
• L3150 Foot, abduction rotation bar, without shoes
• L3160 Foot, adjustable shoe-styled positioning device
• L3161 Foot, adductus positioning device, adjustable
• L3170 Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each
• L3201 Orthopedic shoe, oxford with supinator or pronator, infant
• L3202 Orthopedic shoe, oxford with supinator or pronator, child
• L3203 Orthopedic shoe, oxford with supinator or pronator, junior
• L3204 Orthopedic shoe, hightop with supinator or pronator, infant
• L3206 Orthopedic shoe, hightop with supinator or pronator, child
• L3207 Orthopedic shoe, hightop with supinator or pronator, junior
• L3208 Surgical boot, each, infant
• L3209 Surgical boot, each, child
• L3211 Surgical boot, each, junior
• L3212 Benesch boot, pair, infant
• L3213 Benesch boot, pair, child
• L3214 Benesch boot, pair, junior
• L3215 Orthopedic footwear, ladies shoe, oxford, each
• L3216 Orthopedic footwear, ladies shoe, depth inlay, each
• L3217 Orthopedic footwear, ladies shoe, hightop, depth inlay, each
• L3219 Orthopedic footwear, mens shoe, oxford, each
• L3221 Orthopedic footwear, mens shoe, depth inlay, each
• L3222 Orthopedic footwear, mens shoe, hightop, depth inlay, each
• L3224 Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthosis)
• L3225 Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis)
• L3230 Orthopedic footwear, custom shoe, depth inlay, each
• L3250 Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each
• L3251 Foot, shoe molded to patient model, silicone shoe, each
• L3252 Foot, shoe molded to patient model, plastazote (or similar), custom fabricated, each
• L3253 Foot, molded shoe plastazote (or similar) custom fitted, each
• L3254 Non-standard size or width
• L3255 Non-standard size or length
• L3257 Orthopedic footwear, additional charge for split size
• L3260 Surgical boot/shoe, each
• L3265 Plastazote sandal, each
• L3300 Lift, elevation, heel, tapered to metatarsals, per inch
• L3310 Lift, elevation, heel and sole, neoprene, per inch
• L3320 Lift, elevation, heel and sole, cork, per inch
• L3330 Lift, elevation, metal extension (skate)
• L3332 Lift, elevation, inside shoe, tapered, up to one-half inch
• L3334 Lift, elevation, heel, per inch
• L3340 Heel wedge, sach
• L3350 Heel wedge
• L3360 Sole wedge, outside sole
• L3370 Sole wedge, between sole
• L3380 Clubfoot wedge
• L3390 Outflare wedge
• L3400 Metatarsal bar wedge, rocker
• L3410 Metatarsal bar wedge, between sole
• L3420 Full sole and heel wedge, between sole
• L3430 Heel, counter, plastic reinforced
• L3440 Heel, counter, leather reinforced
• L3450 Heel, sach cushion type
• L3455 Heel, new leather, standard
• L3460 Heel, new rubber, standard
• L3465 Heel, thomas with wedge
• L3470 Heel, thomas extended to ball
• L3480 Heel, pad and depression for spur
• L3485 Heel, pad, removable for spur
• L3500 Orthopedic shoe addition, insole, leather
• L3510 Orthopedic shoe addition, insole, rubber
• L3520 Orthopedic shoe addition, insole, felt covered with leather
• L3530 Orthopedic shoe addition, sole, half
• L3540 Orthopedic shoe addition, sole, full
• L3550 Orthopedic shoe addition, toe tap standard
• L3560 Orthopedic shoe addition, toe tap, horseshoe
• L3570 Orthopedic shoe addition, special extension to instep (leather with eyelets)
• L3580 Orthopedic shoe addition, convert instep to velcro closure
• L3590 Orthopedic shoe addition, convert firm shoe counter to soft counter
• L3595 Orthopedic shoe addition, march bar
• L3600 Transfer of an orthosis from one shoe to another, caliper plate, existing
• L3610 Transfer of an orthosis from one shoe to another, caliper plate, new
• L3620 Transfer of an orthosis from one shoe to another, solid stirrup, existing
• L3630 Transfer of an orthosis from one shoe to another, solid stirrup, new
• L3640 Transfer of an orthosis from one shoe to another, dennis browne splint (riveton), both shoes
• L3649 Orthopedic shoe, modification, addition or transfer, not otherwise specified
• L3650 Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf
• L3660 Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf
• L3670 Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf
• L3671 Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
• L3674 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 Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf
• L3677 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 Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated, off-the-shelf
• L3702 Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
• L3710 Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf
• L3720 Elbow orthosis, double upright with forearm/arm cuffs, free motion, custom fabricated
• L3730 Elbow orthosis, double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated
• L3740 Elbow orthosis, double upright with forearm/arm cuffs, adjustable position lock with active control, custom fabricated
• L3760 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 Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, off-the-shelf
• L3762 Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf
• L3763 Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
• L3764 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 Elbow wrist hand finger orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
• L3766 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 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 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 Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment
• L3809 Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type
• L3891 Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each
• L3900 Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, wrist or finger driven, custom fabricated
• L3901 Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom fabricated
• L3904 Wrist hand finger orthosis, external powered, electric, custom fabricated
• L3905 Wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
• L3906 Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
• L3908 Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf
• L3912 Hand finger orthosis (hfo), flexion glove with elastic finger control, prefabricated, off-the-shelf
• L3913 Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
• L3915 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 Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf
• L3917 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 Hand orthosis, metacarpal fracture orthosis, prefabricated, off-the-shelf
• L3919 Hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
• L3921 Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
• L3923 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 Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, off-the-shelf
• L3925 Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf
• L3927 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 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 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 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 Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment
• L3935 Finger orthosis, nontorsion joint, may include soft interface, custom fabricated, includes fitting and adjustment
• L3956 Addition of joint to upper extremity orthosis, any material; per joint
• L3960 Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment
• 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
• L5615 Addition, endoskeletal knee-shin system, 4 bar linkage or multiaxial, fluid swing and stance 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)
• L5657 Addition to lower extremity prosthesis, manual/automated adjustable air, fluid, gel or equal socket insert for limb volume management, any materials
• 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, with or without perforations, with or without breathable material, 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, with or without perforations, with or without breathable material, 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
• L5783 Addition to lower extremity, user adjustable, mechanical, residual limb volume management system (with or without lamination kit)
• 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
• L5827 Endoskeletal knee-shin system, single axis, electromechanical swing and stance phase control, with or without shock absorption and stance extension damping
• 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
• L5841 Addition, endoskeletal knee-shin system, polycentric, pneumatic swing, and stance 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
• L5926 Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type
• 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
• L5991 Addition to lower extremity prostheses, osseointegrated external prosthetic connector
• L5992 All lower extremity prosthesis, foot shell for modular foot/non-solid ankle cushion heel (sach) replacement only
• 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)
• L6028 Partial hand, finger, and thumb prosthesis without prosthetic digit(s) /thumb, amputation at metacarpal level, including flexible or non-flexible interface, molded to patient model, for use without external power and/or passive prosthetic digit/thumb, not including inserts described by l6692
• L6029 Upper extremity addition, test socket/interface, partial hand including fingers
• L6030 Upper extremity addition, external frame, partial hand including fingers
• L6031 Replacement socket/interface, partial hand including fingers, molded to patient model, for use with or without external power
• L6032 Addition to upper extremity prosthesis, partial hand including fingers, ultralight material (titanium, carbon fiber or equal)
• L6033 Addition to upper extremity prosthesis, partial hand including fingers, acrylic material
• L6034 Partial hand, finger, and thumb prosthesis without prosthetic digit(s)/thumb, amputation at distal to metacarpal joint, including flexible or non-flexible interface, molded to patient model, for use without external power and/or passive prosthetic digit/thumb, not including inserts described by l6692
• L6035 Single prosthetic digit, mechanical, can include metacarpophalangeal (mcp), proximal interphalangeal (pip), and/or distal interphalangeal (dip) joint(s), with or without locking mechanism, can include flexion or extension assist, any material, attachment, initial issue or replacement
• L6036 Prosthetic thumb, mechanical, can include metacarpophalangeal (mcp), interphalangeal (ip) joint(s), with or without locking mechanism, can include flexion or extension assist, any material, attachment, initial issue or replacement
• L6037 Immediate post-surgical or early fitting, application of initial rigid dressing, including fitting alignment and suspension of components, and one cast change, partial hand including fingers
• L6038 Addition to single prosthetic digit or thumb, mechanical, attachment, multiaxial and/or internal/external rotation/abduction/adduction mechanism, with or without locking feature, any material
• L6039 Passive prosthetic digit or thumb prosthesis not including hand restoration partial hand, full or partial, custom made, any material, initial or replacement, per single passive prosthetic digit or thumb
• 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, with or without locking mechanism, 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, lock mechanism, excludes socket insert
• L6700 Upper extremity addition, external powered feature, myoelectronic control module, additional emg inputs, pattern-recognition decoding intent movement
• 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
• L7406 Addition to upper extremity prosthesis, user adjustable, mechanical, residual limb volume management system (with or without lamination kit)
• 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
• L8720 External lower extremity sensory prosthetic device, cutaneous stimulation of mechanoreceptors proximal to the ankle, per leg
• L8721 Receptor sole for use with l8720, replacement, each
• L9900 Orthotic and prosthetic supply, accessory, and/or service component of another hcpcs "l" code