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HCPCS Procedure & Supply Codes

Orthotic Devices & Services

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Orthopedic Shoes

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Orthopedic Footwear

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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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