HCPCS Procedure & Supply Codes

Orthotic Devices & Services

section notes

section notes

section notes

L3201				Oxford w supinat/pronat inf
L3202				Oxford w/ supinat/pronator c
L3203				Oxford w/ supinator/pronator
L3204				Hightop w/ supp/pronator inf
L3206				Hightop w/ supp/pronator chi
L3207				Hightop w/ supp/pronator jun
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 ftwear ladies oxf
L3216				Orthoped ladies shoes dpth i
L3217				Ladies shoes hightop depth i
L3219				Orthopedic mens shoes oxford
L3221				Orthopedic mens shoes dpth i
L3222				Mens shoes hightop depth inl
L3224				Woman's shoe oxford brace
L3225				Man's shoe oxford brace
L3230				Custom shoes depth inlay
L3250				Custom mold shoe remov prost
L3251				Shoe molded to pt silicone s
L3252				Shoe molded plastazote cust
L3253				Shoe molded plastazote cust
L3254				Orth foot non-stndard size/w
L3255				Orth foot non-standard size/
L3257				Orth foot add charge split s
L3260				Ambulatory surgical boot eac
L3265				Plastazote sandal each

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