| 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) |
| 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 |
| 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 |
| 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, any type |
| 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 |
| 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, includes fitting and adjustment |
| 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 |
Afo, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, includes fitting and adjustment |
| 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, includes fitting and adjustment |
| 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, 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 |
| 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 |
| 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 |