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HCPCS Procedure & Supply Codes

Orthotic Devices & Services

section notes

Orthotic Devices -- Upper Limb

section notes

Shoulder-Elbow-Wrist-Hand Orthosis (SEWHO)

section notes
L3975   Shoulder elbow wrist hand finger orthosis, shoulder cap design, without joints, ...
L3976   Shoulder elbow wrist hand finger orthosis, abduction positioning (airplane desig...
L3977   Shoulder elbow wrist hand finger orthosis, shoulder cap design, includes one or ...
L3978   Shoulder elbow wrist hand finger orthosis, abduction positioning (airplane desig...
L3980   Upper extremity fracture orthosis, humeral, prefabricated, includes fitting and ...
L3981   Upper extremity fracture orthosis, humeral, prefabricated, includes shoulder cap...
L3982   Upper extremity fracture orthosis, radius/ulnar, prefabricated, includes fitting...
L3984   Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and ad...
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
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