HCPCS Procedure & Supply Codes

Orthotic Devices & Services

section notes

Orthotic Devices -- Upper Limb

section notes

Shoulder-Elbow-Wrist-Hand Orthosis (SEWHO)

section notes
L3975   Sewhfo cap design w/o jnt cf
L3976   Sewhfo airplane w/o jnts cf
L3977   Sewhfo cap desgn w/jnt(s) cf
L3978   Sewhfo airplane w/jnt(s) cf
L3980   Up ext fx orthos humeral nos
L3981   Ue fx orth shoul cap forearm
L3982   Upper ext fx orthosis rad/ul
L3984   Upper ext fx orthosis wrist
L3995   Sock fracture or equal each
L3999   Upper limb orthosis nos
L4000   Repl girdle milwaukee orth
L4002   Replace strap, any orthosis
L4010   Replace trilateral socket br
L4020   Replace quadlat socket brim
L4030   Replace socket brim cust fit
L4040   Replace molded thigh lacer
L4045   Replace non-molded thigh lac
L4050   Replace molded calf lacer
L4055   Replace non-molded calf lace
L4060   Replace high roll cuff
L4070   Replace prox & dist upright
L4080   Repl met band kafo-afo prox
L4090   Repl met band kafo-afo calf/
L4100   Repl leath cuff kafo prox th
L4110   Repl leath cuff kafo-afo cal
L4130   Replace pretibial shell
L4205   Ortho dvc repair per 15 min
L4210   Orth dev repair/repl minor p
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