L0000–L9999: Orthotic and Prosthetic Procedures, Devices

HCPC SEQNUM RECID LONG DESCRIPTION SHORT DESCRIPTION
L0112 0010 3 Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated Cranial cervical orthosis
L0113 0010 3 Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment Cranial cervical torticollis
L0120 0010 3 Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar) Cerv flex n/adj foam pre ots
L0130 0010 3 Cervical, flexible, thermoplastic collar, molded to patient Flex thermoplastic collar mo
L0140 0010 3 Cervical, semi-rigid, adjustable (plastic collar) Cervical semi-rigid adjustab
L0150 0010 3 Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibular/occipital piece) Cerv semi-rig adj molded chn
L0160 0010 3 Cervical, semi-rigid, wire frame occipital/mandibular support, prefabricated, off-the-shelf Cerv sr wire occ/man pre ots
L0170 0010 3 Cervical, collar, molded to patient model Cervical collar molded to pt
L0172 0010 3 Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf Cerv col sr foam 2pc pre ots
L0174 0010 3 Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf Cerv sr 2pc thor ext pre ots
L0180 0010 3 Cervical, multiple post collar, occipital/mandibular supports, adjustable Cer post col occ/man sup adj
L0190 0010 3 Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars (somi, guilford, taylor types) Cerv collar supp adj cerv ba
L0200 0010 3 Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars, and thoracic extension Cerv col supp adj bar & thor
L0220 0010 3 Thoracic, rib belt, custom fabricated Thor rib belt custom fabrica
L0450 0010 3 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 Tlso flex trunk/thor pre ots
L0452 0010 3 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 Tlso flex custom fab thoraci
L0454 0010 3 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 Tlso trnk sj-t9 pre cst
L0455 0010 3 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 Tlso flex trnk sj-t9 pre ots
L0456 0010 3 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 Tlso flex trnk sj-ss pre cst
L0457 0010 3 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 Tlso flex trnk sj-ss pre ots
L0458 0010 3 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 Tlso 2mod symphis-xipho pre
L0460 0010 3 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 Tlso 2 shl symphys-stern cst
L0462 0010 3 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 Tlso 3mod sacro-scap pre
L0464 0010 3 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 Tlso 4mod sacro-scap pre
L0466 0010 3 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 Tlso r fram soft ant pre cst
L0467 0010 3 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 Tlso r fram soft pre ots
L0468 0010 3 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 Tlso rig fram pelvic pre cst
L0469 0010 3 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 Tlso rig fram pelvic pre ots
L0470 0010 3 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 Tlso rigid frame pre subclav
L0472 0010 3 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 Tlso rigid frame hyperex pre
L0480 0010 3 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 Tlso rigid plastic custom fa
L0482 0010 3 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 Tlso rigid lined custom fab
L0484 0010 3 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 Tlso rigid plastic cust fab
L0486 0010 3 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 Tlso rigidlined cust fab two
L0488 0010 3 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 Tlso rigid lined pre one pie
L0490 0010 3 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 Tlso rigid plastic pre one
L0491 0010 3 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 Tlso 2 piece rigid shell
L0492 0010 3 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 Tlso 3 piece rigid shell
L0621 0010 3 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 Sio flex pelvic/sacr pre ots
L0622 0010 3 Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated Sio flex pelvisacral custom
L0623 0010 3 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 Sio rig pnl pelv/sac pre ots
L0624 0010 3 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 Sio panel custom
L0625 0010 3 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 Lo flex l1-below l5 pre ots
L0626 0010 3 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 Lo sag rig pnl stays pre cst
L0627 0010 3 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 Lo sag ri an/pos pnl pre cst
L0628 0010 3 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 Lso flex no ri stays pre ots
L0629 0010 3 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 Lso flex w/rigid stays cust
L0630 0010 3 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 Lso r post pnl sj-t9 pre cst
L0631 0010 3 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 Lso sag r an/pos pnl pre cst
L0632 0010 3 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 Lso sag rigid frame cust
L0633 0010 3 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 Lso sc r pos/lat pnl pre cst
L0634 0010 3 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 Lso flexion control custom
L0635 0010 3 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 Lso sagit rigid panel prefab
L0636 0010 3 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 Lso sagittal rigid panel cus
L0637 0010 3 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 Lso sc r ant/pos pnl pre cst
L0638 0010 3 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 Lso sag-coronal panel custom
L0639 0010 3 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 Lso s/c shell/panel prefab
L0640 0010 3 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 Lso s/c shell/panel custom
L0641 0010 3 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 Lo rig pos pnl l1-l5 pre ots
L0642 0010 3 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 Lo sag ri an/pos pnl pre ots
L0643 0010 3 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 Lso sag ctr rigi pos pre ots
L0648 0010 3 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 Lso sag r an/pos pnl pre ots
L0649 0010 3 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 Lso sc r pos/lat pnl pre ots
L0650 0010 3 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 Lso sc r ant/pos pnl pre ots
L0651 0010 3 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 Lso sag-co shell pnl pre ots
L0700 0010 3 Cervical-thoracic-lumbar-sacral-orthoses (ctlso), anterior-posterior-lateral control, molded to patient model, (minerva type) Ctlso a-p-l control molded
L0710 0010 3 Ctlso, anterior-posterior-lateral-control, molded to patient model, with interface material, (minerva type) Ctlso a-p-l control w/ inter
L0810 0010 3 Halo procedure, cervical halo incorporated into jacket vest Halo cervical into jckt vest
L0820 0010 3 Halo procedure, cervical halo incorporated into plaster body jacket Halo cervical into body jack
L0830 0010 3 Halo procedure, cervical halo incorporated into milwaukee type orthosis Halo cerv into milwaukee typ
L0859 0010 3 Addition to halo procedure, magnetic resonance image compatible systems, rings and pins, any material Mri compatible system
L0861 0010 3 Addition to halo procedure, replacement liner/interface material Halo repl liner/interface
L0970 0010 3 Tlso, corset front Tlso corset front
L0972 0010 3 Lso, corset front Lso corset front
L0974 0010 3 Tlso, full corset Tlso full corset
L0976 0010 3 Lso, full corset Lso full corset
L0978 0010 3 Axillary crutch extension Axillary crutch extension
L0980 0010 3 Peroneal straps, prefabricated, off-the-shelf, pair Peroneal straps pair pre ots
L0982 0010 3 Stocking supporter grips, prefabricated, off-the-shelf, set of four (4) Stocking sup grips 4 pre ots
L0984 0010 3 Protective body sock, prefabricated, off-the-shelf, each Protect body sock ea pre ots
L0999 0010 3 Addition to spinal orthosis, not otherwise specified Add to spinal orthosis nos
L1000 0010 3 Cervical-thoracic-lumbar-sacral orthosis (ctlso) (milwaukee), inclusive of furnishing initial orthosis, including model Ctlso milwauke initial model
L1001 0010 3 Cervical thoracic lumbar sacral orthosis, immobilizer, infant size, prefabricated, includes fitting and adjustment Ctlso infant immobilizer
L1005 0010 3 Tension based scoliosis orthosis and accessory pads, includes fitting and adjustment Tension based scoliosis orth
L1010 0010 3 Addition to cervical-thoracic-lumbar-sacral orthosis (ctlso) or scoliosis orthosis, axilla sling Ctlso axilla sling
L1020 0010 3 Addition to ctlso or scoliosis orthosis, kyphosis pad Kyphosis pad
L1025 0010 3 Addition to ctlso or scoliosis orthosis, kyphosis pad, floating Kyphosis pad floating
L1030 0010 3 Addition to ctlso or scoliosis orthosis, lumbar bolster pad Lumbar bolster pad
L1040 0010 3 Addition to ctlso or scoliosis orthosis, lumbar or lumbar rib pad Lumbar or lumbar rib pad
L1050 0010 3 Addition to ctlso or scoliosis orthosis, sternal pad Sternal pad
L1060 0010 3 Addition to ctlso or scoliosis orthosis, thoracic pad Thoracic pad
L1070 0010 3 Addition to ctlso or scoliosis orthosis, trapezius sling Trapezius sling
L1080 0010 3 Addition to ctlso or scoliosis orthosis, outrigger Outrigger
L1085 0010 3 Addition to ctlso or scoliosis orthosis, outrigger, bilateral with vertical extensions Outrigger bil w/ vert extens
L1090 0010 3 Addition to ctlso or scoliosis orthosis, lumbar sling Lumbar sling
L1100 0010 3 Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather Ring flange plastic/leather
L1110 0010 3 Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather, molded to patient model Ring flange plas/leather mol
L1120 0010 3 Addition to ctlso, scoliosis orthosis, cover for upright, each Covers for upright each
L1200 0010 3 Thoracic-lumbar-sacral-orthosis (tlso), inclusive of furnishing initial orthosis only Furnsh initial orthosis only
L1210 0010 3 Addition to tlso, (low profile), lateral thoracic extension Lateral thoracic extension
L1220 0010 3 Addition to tlso, (low profile), anterior thoracic extension Anterior thoracic extension
L1230 0010 3 Addition to tlso, (low profile), milwaukee type superstructure Milwaukee type superstructur
L1240 0010 3 Addition to tlso, (low profile), lumbar derotation pad Lumbar derotation pad
L1250 0010 3 Addition to tlso, (low profile), anterior asis pad Anterior asis pad
L1260 0010 3 Addition to tlso, (low profile), anterior thoracic derotation pad Anterior thoracic derotation
L1270 0010 3 Addition to tlso, (low profile), abdominal pad Abdominal pad
L1280 0010 3 Addition to tlso, (low profile), rib gusset (elastic), each Rib gusset (elastic) each
L1290 0010 3 Addition to tlso, (low profile), lateral trochanteric pad Lateral trochanteric pad
L1300 0010 3 Other scoliosis procedure, body jacket molded to patient model Body jacket mold to patient
L1310 0010 3 Other scoliosis procedure, post-operative body jacket Post-operative body jacket
L1499 0010 3 Spinal orthosis, not otherwise specified Spinal orthosis nos
L1600 0010 3 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 Ho flex frejka w/cov pre cst
L1610 0010 3 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 Ho frejka cov only pre cst
L1620 0010 3 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 Ho flex pavlik harns pre cst
L1630 0010 3 Hip orthosis, abduction control of hip joints, semi-flexible (von rosen type), custom fabricated Abduct control hip semi-flex
L1640 0010 3 Hip orthosis, abduction control of hip joints, static, pelvic band or spreader bar, thigh cuffs, custom fabricated Pelv band/spread bar thigh c
L1650 0010 3 Hip orthosis, abduction control of hip joints, static, adjustable, (ilfled type), prefabricated, includes fitting and adjustment Ho abduction hip adjustable
L1652 0010 3 Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, includes fitting and adjustment, any type Ho bi thighcuffs w sprdr bar
L1660 0010 3 Hip orthosis, abduction control of hip joints, static, plastic, prefabricated, includes fitting and adjustment Ho abduction static plastic
L1680 0010 3 Hip orthosis, abduction control of hip joints, dynamic, pelvic control, adjustable hip motion control, thigh cuffs (rancho hip action type), custom fabricated Pelvic & hip control thigh c
L1685 0010 3 Hip orthosis, abduction control of hip joint, postoperative hip abduction type, custom fabricated Post-op hip abduct custom fa
L1686 0010 3 Hip orthosis, abduction control of hip joint, postoperative hip abduction type, prefabricated, includes fitting and adjustment Ho post-op hip abduction
L1690 0010 3 Combination, bilateral, lumbo-sacral, hip, femur orthosis providing adduction and internal rotation control, prefabricated, includes fitting and adjustment Combination bilateral ho
L1700 0010 3 Legg perthes orthosis, (toronto type), custom fabricated Leg perthes orth toronto typ
L1710 0010 3 Legg perthes orthosis, (newington type), custom fabricated Legg perthes orth newington
L1720 0010 3 Legg perthes orthosis, trilateral, (tachdijan type), custom fabricated Legg perthes orthosis trilat
L1730 0010 3 Legg perthes orthosis, (scottish rite type), custom fabricated Legg perthes orth scottish r
L1755 0010 3 Legg perthes orthosis, (patten bottom type), custom fabricated Legg perthes patten bottom t
L1810 0010 3 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 Ko elastic with joints
L1812 0010 3 Knee orthosis, elastic with joints, prefabricated, off-the-shelf Ko elastic w/joints pre ots
L1820 0010 3 Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, includes fitting and adjustment Ko elas w/ condyle pads & jo
L1830 0010 3 Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf Ko immob canvas long pre ots
L1831 0010 3 Knee orthosis, locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment Knee orth pos locking joint
L1832 0010 3 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 Ko adj jnt pos r sup pre cst
L1833 0010 3 Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf Ko adj jnt pos r sup pre ots
L1834 0010 3 Knee orthosis, without knee joint, rigid, custom fabricated Ko w/0 joint rigid molded to
L1836 0010 3 Knee orthosis, rigid, without joint(s), includes soft interface material, prefabricated, off-the-shelf Ko rigid w/o joints pre ots
L1840 0010 3 Knee orthosis, derotation, medial-lateral, anterior cruciate ligament, custom fabricated Ko derot ant cruciate custom
L1843 0010 3 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 Ko single upright pre cst
L1844 0010 3 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 Ko w/adj jt rot cntrl molded
L1845 0010 3 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 Ko double upright pre cst
L1846 0010 3 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 Ko w adj flex/ext rotat mold
L1847 0010 3 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 Ko dbl upright w/air pre cst
L1848 0010 3 Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated, off-the-shelf Ko dbl upright w/air pre ots
L1850 0010 3 Knee orthosis, swedish type, prefabricated, off-the-shelf Ko swedish type pre ots
L1851 0010 3 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 Ko single upright prefab ots
L1852 0010 3 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 Ko double upright prefab ots
L1860 0010 3 Knee orthosis, modification of supracondylar prosthetic socket, custom fabricated (sk) Ko supracondylar socket mold
L1900 0010 3 Ankle foot orthosis, spring wire, dorsiflexion assist calf band, custom fabricated Afo sprng wir drsflx calf bd
L1902 0010 3 Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf Afo ankle gauntlet pre ots
L1904 0010 3 Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated Afo molded ankle gauntlet
L1906 0010 3 Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf Afo multilig ank sup pre ots
L1907 0010 3 Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated Afo supramalleolar custom
L1910 0010 3 Ankle foot orthosis, posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment Afo sing bar clasp attach sh
L1920 0010 3 Ankle foot orthosis, single upright with static or adjustable stop (phelps or perlstein type), custom fabricated Afo sing upright w/ adjust s
L1930 0010 3 Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment Afo plastic
L1932 0010 3 Afo, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, includes fitting and adjustment Afo rig ant tib prefab tcf/=
L1940 0010 3 Ankle foot orthosis, plastic or other material, custom fabricated Afo molded to patient plasti
L1945 0010 3 Ankle foot orthosis, plastic, rigid anterior tibial section (floor reaction), custom fabricated Afo molded plas rig ant tib
L1950 0010 3 Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic, custom fabricated Afo spiral molded to pt plas
L1951 0010 3 Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, includes fitting and adjustment Afo spiral prefabricated
L1960 0010 3 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated Afo pos solid ank plastic mo
L1970 0010 3 Ankle foot orthosis, plastic with ankle joint, custom fabricated Afo plastic molded w/ankle j
L1971 0010 3 Ankle foot orthosis, plastic or other material with ankle joint, prefabricated, includes fitting and adjustment Afo w/ankle joint, prefab
L1980 0010 3 Ankle foot orthosis, single upright free plantar dorsiflexion, solid stirrup, calf band/cuff (single bar ‘bk’ orthosis), custom fabricated Afo sing solid stirrup calf
L1990 0010 3 Ankle foot orthosis, double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar ‘bk’ orthosis), custom fabricated Afo doub solid stirrup calf
L2000 0010 3 Knee ankle foot orthosis, single upright, free knee, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar ‘ak’ orthosis), custom fabricated Kafo sing fre stirr thi/calf
L2005 0010 3 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 Kafo sng/dbl mechanical act
L2006 0010 3 Knee ankle foot device, any material, single or double upright, swing and/or 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 Kaf sng/dbl swg/stn mcpr cus
L2010 0010 3 Knee ankle foot orthosis, single upright, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar ‘ak’ orthosis), without knee joint, custom fabricated Kafo sng solid stirrup w/o j
L2020 0010 3 Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs (double bar ‘ak’ orthosis), custom fabricated Kafo dbl solid stirrup band/
L2030 0010 3 Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs, (double bar ‘ak’ orthosis), without knee joint, custom fabricated Kafo dbl solid stirrup w/o j
L2034 0010 3 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 Kafo pla sin up w/wo k/a cus
L2035 0010 3 Knee ankle foot orthosis, full plastic, static (pediatric size), without free motion ankle, prefabricated, includes fitting and adjustment Kafo plastic pediatric size
L2036 0010 3 Knee ankle foot orthosis, full plastic, double upright, with or without free motion knee, with or without free motion ankle, custom fabricated Kafo plas doub free knee mol
L2037 0010 3 Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, with or without free motion ankle, custom fabricated Kafo plas sing free knee mol
L2038 0010 3 Knee ankle foot orthosis, full plastic, with or without free motion knee, multi-axis ankle, custom fabricated Kafo w/o joint multi-axis an
L2040 0010 3 Hip knee ankle foot orthosis, torsion control, bilateral rotation straps, pelvic band/belt, custom fabricated Hkafo torsion bil rot straps
L2050 0010 3 Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, hip joint, pelvic band/belt, custom fabricated Hkafo torsion cable hip pelv
L2060 0010 3 Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, ball bearing hip joint, pelvic band/ belt, custom fabricated Hkafo torsion ball bearing j
L2070 0010 3 Hip knee ankle foot orthosis, torsion control, unilateral rotation straps, pelvic band/belt, custom fabricated Hkafo torsion unilat rot str
L2080 0010 3 Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, hip joint, pelvic band/belt, custom fabricated Hkafo unilat torsion cable
L2090 0010 3 Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, ball bearing hip joint, pelvic band/ belt, custom fabricated Hkafo unilat torsion ball br
L2106 0010 3 Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, thermoplastic type casting material, custom fabricated Afo tib fx cast plaster mold
L2108 0010 3 Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, custom fabricated Afo tib fx cast molded to pt
L2112 0010 3 Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment Afo tibial fracture soft
L2114 0010 3 Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment Afo tib fx semi-rigid
L2116 0010 3 Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, rigid, prefabricated, includes fitting and adjustment Afo tibial fracture rigid
L2126 0010 3 Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, thermoplastic type casting material, custom fabricated Kafo fem fx cast thermoplas
L2128 0010 3 Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, custom fabricated Kafo fem fx cast molded to p
L2132 0010 3 Kafo, fracture orthosis, femoral fracture cast orthosis, soft, prefabricated, includes fitting and adjustment Kafo femoral fx cast soft
L2134 0010 3 Kafo, fracture orthosis, femoral fracture cast orthosis, semi-rigid, prefabricated, includes fitting and adjustment Kafo fem fx cast semi-rigid
L2136 0010 3 Kafo, fracture orthosis, femoral fracture cast orthosis, rigid, prefabricated, includes fitting and adjustment Kafo femoral fx cast rigid
L2180 0010 3 Addition to lower extremity fracture orthosis, plastic shoe insert with ankle joints Plas shoe insert w ank joint
L2182 0010 3 Addition to lower extremity fracture orthosis, drop lock knee joint Drop lock knee
L2184 0010 3 Addition to lower extremity fracture orthosis, limited motion knee joint Limited motion knee joint
L2186 0010 3 Addition to lower extremity fracture orthosis, adjustable motion knee joint, lerman type Adj motion knee jnt lerman t
L2188 0010 3 Addition to lower extremity fracture orthosis, quadrilateral brim Quadrilateral brim
L2190 0010 3 Addition to lower extremity fracture orthosis, waist belt Waist belt
L2192 0010 3 Addition to lower extremity fracture orthosis, hip joint, pelvic band, thigh flange, and pelvic belt Pelvic band & belt thigh fla
L2200 0010 3 Addition to lower extremity, limited ankle motion, each joint Limited ankle motion ea jnt
L2210 0010 3 Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint Dorsiflexion assist each joi
L2220 0010 3 Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint Dorsi & plantar flex ass/res
L2230 0010 3 Addition to lower extremity, split flat caliper stirrups and plate attachment Split flat caliper stirr & p
L2232 0010 3 Addition to lower extremity orthosis, rocker bottom for total contact ankle foot orthosis, for custom fabricated orthosis only Rocker bottom, contact afo
L2240 0010 3 Addition to lower extremity, round caliper and plate attachment Round caliper and plate atta
L2250 0010 3 Addition to lower extremity, foot plate, molded to patient model, stirrup attachment Foot plate molded stirrup at
L2260 0010 3 Addition to lower extremity, reinforced solid stirrup (scott-craig type) Reinforced solid stirrup
L2265 0010 3 Addition to lower extremity, long tongue stirrup Long tongue stirrup
L2270 0010 3 Addition to lower extremity, varus/valgus correction (‘t’) strap, padded/lined or malleolus pad Varus/valgus strap padded/li
L2275 0010 3 Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined Plastic mod low ext pad/line
L2280 0010 3 Addition to lower extremity, molded inner boot Molded inner boot
L2300 0010 3 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable Abduction bar jointed adjust
L2310 0010 3 Addition to lower extremity, abduction bar-straight Abduction bar-straight
L2320 0010 3 Addition to lower extremity, non-molded lacer, for custom fabricated orthosis only Non-molded lacer
L2330 0010 3 Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only Lacer molded to patient mode
L2335 0010 3 Addition to lower extremity, anterior swing band Anterior swing band
L2340 0010 3 Addition to lower extremity, pre-tibial shell, molded to patient model Pre-tibial shell molded to p
L2350 0010 3 Addition to lower extremity, prosthetic type, (bk) socket, molded to patient model, (used for ‘ptb’ ‘afo’ orthoses) Prosthetic type socket molde
L2360 0010 3 Addition to lower extremity, extended steel shank Extended steel shank
L2370 0010 3 Addition to lower extremity, patten bottom Patten bottom
L2375 0010 3 Addition to lower extremity, torsion control, ankle joint and half solid stirrup Torsion ank & half solid sti
L2380 0010 3 Addition to lower extremity, torsion control, straight knee joint, each joint Torsion straight knee joint
L2385 0010 3 Addition to lower extremity, straight knee joint, heavy duty, each joint Straight knee joint heavy du
L2387 0010 3 Addition to lower extremity, polycentric knee joint, for custom fabricated knee ankle foot orthosis, each joint Add le poly knee custom kafo
L2390 0010 3 Addition to lower extremity, offset knee joint, each joint Offset knee joint each
L2395 0010 3 Addition to lower extremity, offset knee joint, heavy duty, each joint Offset knee joint heavy duty
L2397 0010 3 Addition to lower extremity orthosis, suspension sleeve Suspension sleeve lower ext
L2405 0010 3 Addition to knee joint, drop lock, each Knee joint drop lock ea jnt
L2415 0010 3 Addition to knee lock with integrated release mechanism (bail, cable, or equal), any material, each joint Knee joint cam lock each joi
L2425 0010 3 Addition to knee joint, disc or dial lock for adjustable knee flexion, each joint Knee disc/dial lock/adj flex
L2430 0010 3 Addition to knee joint, ratchet lock for active and progressive knee extension, each joint Knee jnt ratchet lock ea jnt
L2492 0010 3 Addition to knee joint, lift loop for drop lock ring Knee lift loop drop lock rin
L2500 0010 3 Addition to lower extremity, thigh/weight bearing, gluteal/ ischial weight bearing, ring Thi/glut/ischia wgt bearing
L2510 0010 3 Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, molded to patient model Th/wght bear quad-lat brim m
L2520 0010 3 Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, custom fitted Th/wght bear quad-lat brim c
L2525 0010 3 Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim molded to patient model Th/wght bear nar m-l brim mo
L2526 0010 3 Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim, custom fitted Th/wght bear nar m-l brim cu
L2530 0010 3 Addition to lower extremity, thigh-weight bearing, lacer, non-molded Thigh/wght bear lacer non-mo
L2540 0010 3 Addition to lower extremity, thigh/weight bearing, lacer, molded to patient model Thigh/wght bear lacer molded
L2550 0010 3 Addition to lower extremity, thigh/weight bearing, high roll cuff Thigh/wght bear high roll cu
L2570 0010 3 Addition to lower extremity, pelvic control, hip joint, clevis type two position joint, each Hip clevis type 2 posit jnt
L2580 0010 3 Addition to lower extremity, pelvic control, pelvic sling Pelvic control pelvic sling
L2600 0010 3 Addition to lower extremity, pelvic control, hip joint, clevis type, or thrust bearing, free, each Hip clevis/thrust bearing fr
L2610 0010 3 Addition to lower extremity, pelvic control, hip joint, clevis or thrust bearing, lock, each Hip clevis/thrust bearing lo
L2620 0010 3 Addition to lower extremity, pelvic control, hip joint, heavy duty, each Pelvic control hip heavy dut
L2622 0010 3 Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each Hip joint adjustable flexion
L2624 0010 3 Addition to lower extremity, pelvic control, hip joint, adjustable flexion, extension, abduction control, each Hip adj flex ext abduct cont
L2627 0010 3 Addition to lower extremity, pelvic control, plastic, molded to patient model, reciprocating hip joint and cables Plastic mold recipro hip & c
L2628 0010 3 Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables Metal frame recipro hip & ca
L2630 0010 3 Addition to lower extremity, pelvic control, band and belt, unilateral Pelvic control band & belt u
L2640 0010 3 Addition to lower extremity, pelvic control, band and belt, bilateral Pelvic control band & belt b
L2650 0010 3 Addition to lower extremity, pelvic and thoracic control, gluteal pad, each Pelv & thor control gluteal
L2660 0010 3 Addition to lower extremity, thoracic control, thoracic band Thoracic control thoracic ba
L2670 0010 3 Addition to lower extremity, thoracic control, paraspinal uprights Thorac cont paraspinal uprig
L2680 0010 3 Addition to lower extremity, thoracic control, lateral support uprights Thorac cont lat support upri
L2750 0010 3 Addition to lower extremity orthosis, plating chrome or nickel, per bar Plating chrome/nickel pr bar
L2755 0010 3 Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only Carbon graphite lamination
L2760 0010 3 Addition to lower extremity orthosis, extension, per extension, per bar (for lineal adjustment for growth) Extension per extension per
L2768 0010 3 Orthotic side bar disconnect device, per bar Ortho sidebar disconnect
L2780 0010 3 Addition to lower extremity orthosis, non-corrosive finish, per bar Non-corrosive finish
L2785 0010 3 Addition to lower extremity orthosis, drop lock retainer, each Drop lock retainer each
L2795 0010 3 Addition to lower extremity orthosis, knee control, full kneecap Knee control full kneecap
L2800 0010 3 Addition to lower extremity orthosis, knee control, knee cap, medial or lateral pull, for use with custom fabricated orthosis only Knee cap medial or lateral p
L2810 0010 3 Addition to lower extremity orthosis, knee control, condylar pad Knee control condylar pad
L2820 0010 3 Addition to lower extremity orthosis, soft interface for molded plastic, below knee section Soft interface below knee se
L2830 0010 3 Addition to lower extremity orthosis, soft interface for molded plastic, above knee section Soft interface above knee se
L2840 0010 3 Addition to lower extremity orthosis, tibial length sock, fracture or equal, each Tibial length sock fx or equ
L2850 0010 3 Addition to lower extremity orthosis, femoral length sock, fracture or equal, each Femoral lgth sock fx or equa
L2861 0010 3 Addition to lower extremity joint, knee or ankle, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each Torsion mechanism knee/ankle
L2999 0010 3 Lower extremity orthoses, not otherwise specified Lower extremity orthosis nos
L3000 0010 3 Foot, insert, removable, molded to patient model, ‘ucb’ type, berkeley shell, each Ft insert ucb berkeley shell
L3001 0010 3 Foot, insert, removable, molded to patient model, spenco, each Foot insert remov molded spe
L3002 0010 3 Foot, insert, removable, molded to patient model, plastazote or equal, each Foot insert plastazote or eq
L3003 0010 3 Foot, insert, removable, molded to patient model, silicone gel, each Foot insert silicone gel eac
L3010 0010 3 Foot, insert, removable, molded to patient model, longitudinal arch support, each Foot longitudinal arch suppo
L3020 0010 3 Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each Foot longitud/metatarsal sup
L3030 0010 3 Foot, insert, removable, formed to patient foot, each Foot arch support remov prem
L3031 0010 3 Foot, insert/plate, removable, addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, each Foot lamin/prepreg composite
L3040 0010 3 Foot, arch support, removable, premolded, longitudinal, each Ft arch suprt premold longit
L3050 0010 3 Foot, arch support, removable, premolded, metatarsal, each Foot arch supp premold metat
L3060 0010 3 Foot, arch support, removable, premolded, longitudinal/ metatarsal, each Foot arch supp longitud/meta
L3070 0010 3 Foot, arch support, non-removable attached to shoe, longitudinal, each Arch suprt att to sho longit
L3080 0010 3 Foot, arch support, non-removable attached to shoe, metatarsal, each Arch supp att to shoe metata
L3090 0010 3 Foot, arch support, non-removable attached to shoe, longitudinal/metatarsal, each Arch supp att to shoe long/m
L3100 0010 3 Hallus-valgus night dynamic splint, prefabricated, off-the-shelf Hallus-valgus nt dyn pre ots
L3140 0010 3 Foot, abduction rotation bar, including shoes Abduction rotation bar shoe
L3150 0010 3 Foot, abduction rotation bar, without shoes Abduct rotation bar w/o shoe
L3160 0010 3 Foot, adjustable shoe-styled positioning device Shoe styled positioning dev
L3170 0010 3 Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each Foot plas heel stabi pre ots
L3201 0010 3 Orthopedic shoe, oxford with supinator or pronator, infant Oxford w supinat/pronat inf
L3202 0010 3 Orthopedic shoe, oxford with supinator or pronator, child Oxford w/ supinat/pronator c
L3203 0010 3 Orthopedic shoe, oxford with supinator or pronator, junior Oxford w/ supinator/pronator
L3204 0010 3 Orthopedic shoe, hightop with supinator or pronator, infant Hightop w/ supp/pronator inf
L3206 0010 3 Orthopedic shoe, hightop with supinator or pronator, child Hightop w/ supp/pronator chi
L3207 0010 3 Orthopedic shoe, hightop with supinator or pronator, junior Hightop w/ supp/pronator jun
L3208 0010 3 Surgical boot, each, infant Surgical boot each infant
L3209 0010 3 Surgical boot, each, child Surgical boot each child
L3211 0010 3 Surgical boot, each, junior Surgical boot each junior
L3212 0010 3 Benesch boot, pair, infant Benesch boot pair infant
L3213 0010 3 Benesch boot, pair, child Benesch boot pair child
L3214 0010 3 Benesch boot, pair, junior Benesch boot pair junior
L3215 0010 3 Orthopedic footwear, ladies shoe, oxford, each Orthopedic ftwear ladies oxf
L3216 0010 3 Orthopedic footwear, ladies shoe, depth inlay, each Orthoped ladies shoes dpth i
L3217 0010 3 Orthopedic footwear, ladies shoe, hightop, depth inlay, each Ladies shoes hightop depth i
L3219 0010 3 Orthopedic footwear, mens shoe, oxford, each Orthopedic mens shoes oxford
L3221 0010 3 Orthopedic footwear, mens shoe, depth inlay, each Orthopedic mens shoes dpth i
L3222 0010 3 Orthopedic footwear, mens shoe, hightop, depth inlay, each Mens shoes hightop depth inl
L3224 0010 3 Orthopedic footwear, woman’s shoe, oxford, used as an integral part of a brace (orthosis) Woman’s shoe oxford brace
L3225 0010 3 Orthopedic footwear, man’s shoe, oxford, used as an integral part of a brace (orthosis) Man’s shoe oxford brace
L3230 0010 3 Orthopedic footwear, custom shoe, depth inlay, each Custom shoes depth inlay
L3250 0010 3 Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each Custom mold shoe remov prost
L3251 0010 3 Foot, shoe molded to patient model, silicone shoe, each Shoe molded to pt silicone s
L3252 0010 3 Foot, shoe molded to patient model, plastazote (or similar), custom fabricated, each Shoe molded plastazote cust
L3253 0010 3 Foot, molded shoe plastazote (or similar) custom fitted, each Shoe molded plastazote cust
L3254 0010 3 Non-standard size or width Orth foot non-stndard size/w
L3255 0010 3 Non-standard size or length Orth foot non-standard size/
L3257 0010 3 Orthopedic footwear, additional charge for split size Orth foot add charge split s
L3260 0010 3 Surgical boot/shoe, each Ambulatory surgical boot eac
L3265 0010 3 Plastazote sandal, each Plastazote sandal each
L3300 0010 3 Lift, elevation, heel, tapered to metatarsals, per inch Sho lift taper to metatarsal
L3310 0010 3 Lift, elevation, heel and sole, neoprene, per inch Shoe lift elev heel/sole neo
L3320 0010 3 Lift, elevation, heel and sole, cork, per inch Shoe lift elev heel/sole cor
L3330 0010 3 Lift, elevation, metal extension (skate) Lifts elevation metal extens
L3332 0010 3 Lift, elevation, inside shoe, tapered, up to one-half inch Shoe lifts tapered to one-ha
L3334 0010 3 Lift, elevation, heel, per inch Shoe lifts elevation heel /i
L3340 0010 3 Heel wedge, sach Shoe wedge sach
L3350 0010 3 Heel wedge Shoe heel wedge
L3360 0010 3 Sole wedge, outside sole Shoe sole wedge outside sole
L3370 0010 3 Sole wedge, between sole Shoe sole wedge between sole
L3380 0010 3 Clubfoot wedge Shoe clubfoot wedge
L3390 0010 3 Outflare wedge Shoe outflare wedge
L3400 0010 3 Metatarsal bar wedge, rocker Shoe metatarsal bar wedge ro
L3410 0010 3 Metatarsal bar wedge, between sole Shoe metatarsal bar between
L3420 0010 3 Full sole and heel wedge, between sole Full sole/heel wedge btween
L3430 0010 3 Heel, counter, plastic reinforced Sho heel count plast reinfor
L3440 0010 3 Heel, counter, leather reinforced Heel leather reinforced
L3450 0010 3 Heel, sach cushion type Shoe heel sach cushion type
L3455 0010 3 Heel, new leather, standard Shoe heel new leather standa
L3460 0010 3 Heel, new rubber, standard Shoe heel new rubber standar
L3465 0010 3 Heel, thomas with wedge Shoe heel thomas with wedge
L3470 0010 3 Heel, thomas extended to ball Shoe heel thomas extend to b
L3480 0010 3 Heel, pad and depression for spur Shoe heel pad & depress for
L3485 0010 3 Heel, pad, removable for spur Shoe heel pad removable for
L3500 0010 3 Orthopedic shoe addition, insole, leather Ortho shoe add leather insol
L3510 0010 3 Orthopedic shoe addition, insole, rubber Orthopedic shoe add rub insl
L3520 0010 3 Orthopedic shoe addition, insole, felt covered with leather O shoe add felt w leath insl
L3530 0010 3 Orthopedic shoe addition, sole, half Ortho shoe add half sole
L3540 0010 3 Orthopedic shoe addition, sole, full Ortho shoe add full sole
L3550 0010 3 Orthopedic shoe addition, toe tap standard O shoe add standard toe tap
L3560 0010 3 Orthopedic shoe addition, toe tap, horseshoe O shoe add horseshoe toe tap
L3570 0010 3 Orthopedic shoe addition, special extension to instep (leather with eyelets) O shoe add instep extension
L3580 0010 3 Orthopedic shoe addition, convert instep to velcro closure O shoe add instep velcro clo
L3590 0010 3 Orthopedic shoe addition, convert firm shoe counter to soft counter O shoe convert to sof counte
L3595 0010 3 Orthopedic shoe addition, march bar Ortho shoe add march bar
L3600 0010 3 Transfer of an orthosis from one shoe to another, caliper plate, existing Trans shoe calip plate exist
L3610 0010 3 Transfer of an orthosis from one shoe to another, caliper plate, new Trans shoe caliper plate new
L3620 0010 3 Transfer of an orthosis from one shoe to another, solid stirrup, existing Trans shoe solid stirrup exi
L3630 0010 3 Transfer of an orthosis from one shoe to another, solid stirrup, new Trans shoe solid stirrup new
L3640 0010 3 Transfer of an orthosis from one shoe to another, dennis browne splint (riveton), both shoes Shoe dennis browne splint bo
L3649 0010 3 Orthopedic shoe, modification, addition or transfer, not otherwise specified Orthopedic shoe modifica nos
L3650 0010 3 Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf So 8 abd restraint pre ots
L3660 0010 3 Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf So 8 ab rstr can/web pre ots
L3670 0010 3 Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf So acro/clav can web pre ots
L3671 0010 3 Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment So cap design w/o jnts cf
L3674 0010 3 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 So airplane w/wo joint cf
L3675 0010 3 Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf So vest canvas/web pre ots
L3677 0010 3 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 So hard plas stabili pre cst
L3678 0010 3 Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated, off-the-shelf So hard plas stabili pre ots
L3702 0010 3 Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment Eo w/o joints cf
L3710 0010 3 Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf Eo elas w/metal jnts pre ots
L3720 0010 3 Elbow orthosis, double upright with forearm/arm cuffs, free motion, custom fabricated Forearm/arm cuffs free motio
L3730 0010 3 Elbow orthosis, double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated Forearm/arm cuffs ext/flex a
L3740 0010 3 Elbow orthosis, double upright with forearm/arm cuffs, adjustable position lock with active control, custom fabricated Cuffs adj lock w/ active con
L3760 0010 3 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 Eo adj jt prefab custom fit
L3761 0010 3 Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, off-the-shelf Eo, adj lock joint prefab ot
L3762 0010 3 Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf Eo rigid w/o joints pre ots
L3763 0010 3 Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment Ewho rigid w/o jnts cf
L3764 0010 3 Elbow wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment Ewho w/joint(s) cf
L3765 0010 3 Elbow wrist hand finger orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment Ewhfo rigid w/o jnts cf
L3766 0010 3 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 Ewhfo w/joint(s) cf
L3806 0010 3 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 Whfo w/joint(s) custom fab
L3807 0010 3 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 Whfo w/o joints pre cst
L3808 0010 3 Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment Whfo, rigid w/o joints
L3809 0010 3 Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type Whfo w/o joints pre ots
L3891 0010 3 Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each Torsion mechanism wrist/elbo
L3900 0010 3 Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, wrist or finger driven, custom fabricated Hinge extension/flex wrist/f
L3901 0010 3 Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom fabricated Hinge ext/flex wrist finger
L3904 0010 3 Wrist hand finger orthosis, external powered, electric, custom fabricated Whfo electric custom fitted
L3905 0010 3 Wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment Who w/nontorsion jnt(s) cf
L3906 0010 3 Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment Who w/o joints cf
L3908 0010 3 Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf Who cock-up nonmolde pre ots
L3912 0010 3 Hand finger orthosis (hfo), flexion glove with elastic finger control, prefabricated, off-the-shelf Hfo flexion glove pre ots
L3913 0010 3 Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment Hfo w/o joints cf
L3915 0010 3 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 Who nontorsion jnts pre cst
L3916 0010 3 Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf Who nontorsion jnts pre ots
L3917 0010 3 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 Metacarp fx orthosis pre cst
L3918 0010 3 Hand orthosis, metacarpal fracture orthosis, prefabricated, off-the-shelf Metacarp fx orthosis pre ots
L3919 0010 3 Hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment Ho w/o joints cf
L3921 0010 3 Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment Hfo w/joint(s) cf
L3923 0010 3 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 Hfo without joints pre cst
L3924 0010 3 Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, off-the-shelf Hfo without joints pre ots
L3925 0010 3 Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf Fo pip dip jnt/sprng pre ots
L3927 0010 3 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 Fo pip dip no jt spr pre ots
L3929 0010 3 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 Hfo nontorsion jnts pre cst
L3930 0010 3 Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, off-the-shelf Hfo nontorsion jnts pre ots
L3931 0010 3 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 Whfo nontorsion joint prefab
L3933 0010 3 Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment Fo w/o joints cf
L3935 0010 3 Finger orthosis, nontorsion joint, may include soft interface, custom fabricated, includes fitting and adjustment Fo nontorsion joint cf
L3956 0010 3 Addition of joint to upper extremity orthosis, any material; per joint Add joint upper ext orthosis
L3960 0010 3 Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment Sewho airplan desig abdu pos
L3961 0010 3 Shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment Sewho cap design w/o jnts cf
L3962 0010 3 Shoulder elbow wrist hand orthosis, abduction positioning, erb’s palsey design, prefabricated, includes fitting and adjustment Sewho erbs palsey design abd
L3967 0010 3 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 Sewho airplane w/o jnts cf
L3971 0010 3 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 Sewho cap design w/jnt(s) cf
L3973 0010 3 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 Sewho airplane w/jnt(s) cf
L3975 0010 3 Shoulder elbow wrist hand finger orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment Sewhfo cap design w/o jnt cf
L3976 0010 3 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 Sewhfo airplane w/o jnts cf
L3977 0010 3 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 Sewhfo cap desgn w/jnt(s) cf
L3978 0010 3 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 Sewhfo airplane w/jnt(s) cf
L3980 0010 3 Upper extremity fracture orthosis, humeral, prefabricated, includes fitting and adjustment Up ext fx orthos humeral nos
L3981 0010 3 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 Ue fx orth shoul cap forearm
L3982 0010 3 Upper extremity fracture orthosis, radius/ulnar, prefabricated, includes fitting and adjustment Upper ext fx orthosis rad/ul
L3984 0010 3 Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment Upper ext fx orthosis wrist
L3995 0010 3 Addition to upper extremity orthosis, sock, fracture or equal, each Sock fracture or equal each
L3999 0010 3 Upper limb orthosis, not otherwise specified Upper limb orthosis nos
L4000 0010 3 Replace girdle for spinal orthosis (ctlso or so) Repl girdle milwaukee orth
L4002 0010 3 Replacement strap, any orthosis, includes all components, any length, any type Replace strap, any orthosis
L4010 0010 3 Replace trilateral socket brim Replace trilateral socket br
L4020 0010 3 Replace quadrilateral socket brim, molded to patient model Replace quadlat socket brim
L4030 0010 3 Replace quadrilateral socket brim, custom fitted Replace socket brim cust fit
L4040 0010 3 Replace molded thigh lacer, for custom fabricated orthosis only Replace molded thigh lacer
L4045 0010 3 Replace non-molded thigh lacer, for custom fabricated orthosis only Replace non-molded thigh lac
L4050 0010 3 Replace molded calf lacer, for custom fabricated orthosis only Replace molded calf lacer
L4055 0010 3 Replace non-molded calf lacer, for custom fabricated orthosis only Replace non-molded calf lace
L4060 0010 3 Replace high roll cuff Replace high roll cuff
L4070 0010 3 Replace proximal and distal upright for kafo Replace prox & dist upright
L4080 0010 3 Replace metal bands kafo, proximal thigh Repl met band kafo-afo prox
L4090 0010 3 Replace metal bands kafo-afo, calf or distal thigh Repl met band kafo-afo calf/
L4100 0010 3 Replace leather cuff kafo, proximal thigh Repl leath cuff kafo prox th
L4110 0010 3 Replace leather cuff kafo-afo, calf or distal thigh Repl leath cuff kafo-afo cal
L4130 0010 3 Replace pretibial shell Replace pretibial shell
L4205 0010 3 Repair of orthotic device, labor component, per 15 minutes Ortho dvc repair per 15 min
L4210 0010 3 Repair of orthotic device, repair or replace minor parts Orth dev repair/repl minor p
L4350 0010 3 Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf Ankle control ortho pre ots
L4360 0010 3 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 Pneumat walking boot pre cst
L4361 0010 3 Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf Pneuma/vac walk boot pre ots
L4370 0010 3 Pneumatic full leg splint, prefabricated, off-the-shelf Pneum full leg splnt pre ots
L4386 0010 3 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 Non-pneum walk boot pre cst
L4387 0010 3 Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf Non-pneum walk boot pre ots
L4392 0010 3 Replacement, soft interface material, static afo Replace afo soft interface
L4394 0010 3 Replace soft interface material, foot drop splint Replace foot drop spint
L4396 0010 3 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 Static or dynami afo pre cst
L4397 0010 3 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 Static or dynami afo pre ots
L4398 0010 3 Foot drop splint, recumbent positioning device, prefabricated, off-the-shelf Foot drop splint pre ots
L4631 0010 3 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 Afo, walk boot type, cus fab
L5000 0010 3 Partial foot, shoe insert with longitudinal arch, toe filler Sho insert w arch toe filler
L5010 0010 3 Partial foot, molded socket, ankle height, with toe filler Mold socket ank hgt w/ toe f
L5020 0010 3 Partial foot, molded socket, tibial tubercle height, with toe filler Tibial tubercle hgt w/ toe f
L5050 0010 3 Ankle, symes, molded socket, sach foot Ank symes mold sckt sach ft
L5060 0010 3 Ankle, symes, metal frame, molded leather socket, articulated ankle/foot Symes met fr leath socket ar
L5100 0010 3 Below knee, molded socket, shin, sach foot Molded socket shin sach foot
L5105 0010 3 Below knee, plastic socket, joints and thigh lacer, sach foot Plast socket jts/thgh lacer
L5150 0010 3 Knee disarticulation (or through knee), molded socket, external knee joints, shin, sach foot Mold sckt ext knee shin sach
L5160 0010 3 Knee disarticulation (or through knee), molded socket, bent knee configuration, external knee joints, shin, sach foot Mold socket bent knee shin s
L5200 0010 3 Above knee, molded socket, single axis constant friction knee, shin, sach foot Kne sing axis fric shin sach
L5210 0010 3 Above knee, short prosthesis, no knee joint (‘stubbies’), with foot blocks, no ankle joints, each No knee/ankle joints w/ ft b
L5220 0010 3 Above knee, short prosthesis, no knee joint (‘stubbies’), with articulated ankle/foot, dynamically aligned, each No knee joint with artic ali
L5230 0010 3 Above knee, for proximal femoral focal deficiency, constant friction knee, shin, sach foot Fem focal defic constant fri
L5250 0010 3 Hip disarticulation, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot Hip canad sing axi cons fric
L5270 0010 3 Hip disarticulation, tilt table type; molded socket, locking hip joint, single axis constant friction knee, shin, sach foot Tilt table locking hip sing
L5280 0010 3 Hemipelvectomy, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot Hemipelvect canad sing axis
L5301 0010 3 Below knee, molded socket, shin, sach foot, endoskeletal system Bk mold socket sach ft endo
L5312 0010 3 Knee disarticulation (or through knee), molded socket, single axis knee, pylon, sach foot, endoskeletal system Knee disart, sach ft, endo
L5321 0010 3 Above knee, molded socket, open end, sach foot, endoskeletal system, single axis knee Ak open end sach
L5331 0010 3 Hip disarticulation, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot Hip disart canadian sach ft
L5341 0010 3 Hemipelvectomy, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot Hemipelvectomy canadian sach
L5400 0010 3 Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment, suspension, and one cast change, below knee Postop dress & 1 cast chg bk
L5410 0010 3 Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension, below knee, each additional cast change and realignment Postop dsg bk ea add cast ch
L5420 0010 3 Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension and one cast change ‘ak’ or knee disarticulation Postop dsg & 1 cast chg ak/d
L5430 0010 3 Immediate post surgical or early fitting, application of initial rigid dressing, incl. fitting, alignment and supension, ‘ak’ or knee disarticulation, each additional cast change and realignment Postop dsg ak ea add cast ch
L5450 0010 3 Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, below knee Postop app non-wgt bear dsg
L5460 0010 3 Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, above knee Postop app non-wgt bear dsg
L5500 0010 3 Initial, below knee ‘ptb’ type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed Init bk ptb plaster direct
L5505 0010 3 Initial, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed Init ak ischal plstr direct
L5510 0010 3 Preparatory, below knee ‘ptb’ type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model Prep bk ptb plaster molded
L5520 0010 3 Preparatory, below knee ‘ptb’ type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed Perp bk ptb thermopls direct
L5530 0010 3 Preparatory, below knee ‘ptb’ type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model Prep bk ptb thermopls molded
L5535 0010 3 Preparatory, below knee ‘ptb’ type socket, non-alignable system, no cover, sach foot, prefabricated, adjustable open end socket Prep bk ptb open end socket
L5540 0010 3 Preparatory, below knee ‘ptb’ type socket, non-alignable system, pylon, no cover, sach foot, laminated socket, molded to model Prep bk ptb laminated socket
L5560 0010 3 Preparatory, above knee- knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model Prep ak ischial plast molded
L5570 0010 3 Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed Prep ak ischial direct form
L5580 0010 3 Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model Prep ak ischial thermo mold
L5585 0010 3 Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, prefabricated adjustable open end socket Prep ak ischial open end
L5590 0010 3 Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon no cover, sach foot, laminated socket, molded to model Prep ak ischial laminated
L5595 0010 3 Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, thermoplastic or equal, molded to patient model Hip disartic sach thermopls
L5600 0010 3 Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, laminated socket, molded to patient model Hip disart sach laminat mold
L5610 0010 3 Addition to lower extremity, endoskeletal system, above knee, hydracadence system Above knee hydracadence
L5611 0010 3 Addition to lower extremity, endoskeletal system, above knee - knee disarticulation, 4 bar linkage, with friction swing phase control Ak 4 bar link w/fric swing
L5613 0010 3 Addition to lower extremity, endoskeletal system, above knee-knee disarticulation, 4 bar linkage, with hydraulic swing phase control Ak 4 bar ling w/hydraul swig
L5614 0010 3 Addition to lower extremity, exoskeletal system, above knee-knee disarticulation, 4 bar linkage, with pneumatic swing phase control 4-bar link above knee w/swng
L5616 0010 3 Addition to lower extremity, endoskeletal system, above knee, universal multiplex system, friction swing phase control Ak univ multiplex sys frict
L5617 0010 3 Addition to lower extremity, quick change self-aligning unit, above knee or below knee, each Ak/bk self-aligning unit ea
L5618 0010 3 Addition to lower extremity, test socket, symes Test socket symes
L5620 0010 3 Addition to lower extremity, test socket, below knee Test socket below knee
L5622 0010 3 Addition to lower extremity, test socket, knee disarticulation Test socket knee disarticula
L5624 0010 3 Addition to lower extremity, test socket, above knee Test socket above knee
L5626 0010 3 Addition to lower extremity, test socket, hip disarticulation Test socket hip disarticulat
L5628 0010 3 Addition to lower extremity, test socket, hemipelvectomy Test socket hemipelvectomy
L5629 0010 3 Addition to lower extremity, below knee, acrylic socket Below knee acrylic socket
L5630 0010 3 Addition to lower extremity, symes type, expandable wall socket Syme typ expandabl wall sckt
L5631 0010 3 Addition to lower extremity, above knee or knee disarticulation, acrylic socket Ak/knee disartic acrylic soc
L5632 0010 3 Addition to lower extremity, symes type, ‘ptb’ brim design socket Symes type ptb brim design s
L5634 0010 3 Addition to lower extremity, symes type, posterior opening (canadian) socket Symes type poster opening so
L5636 0010 3 Addition to lower extremity, symes type, medial opening socket Symes type medial opening so
L5637 0010 3 Addition to lower extremity, below knee, total contact Below knee total contact
L5638 0010 3 Addition to lower extremity, below knee, leather socket Below knee leather socket
L5639 0010 3 Addition to lower extremity, below knee, wood socket Below knee wood socket
L5640 0010 3 Addition to lower extremity, knee disarticulation, leather socket Knee disarticulat leather so
L5642 0010 3 Addition to lower extremity, above knee, leather socket Above knee leather socket
L5643 0010 3 Addition to lower extremity, hip disarticulation, flexible inner socket, external frame Hip flex inner socket ext fr
L5644 0010 3 Addition to lower extremity, above knee, wood socket Above knee wood socket
L5645 0010 3 Addition to lower extremity, below knee, flexible inner socket, external frame Bk flex inner socket ext fra
L5646 0010 3 Addition to lower extremity, below knee, air, fluid, gel or equal, cushion socket Below knee cushion socket
L5647 0010 3 Addition to lower extremity, below knee suction socket Below knee suction socket
L5648 0010 3 Addition to lower extremity, above knee, air, fluid, gel or equal, cushion socket Above knee cushion socket
L5649 0010 3 Addition to lower extremity, ischial containment/narrow m-l socket Isch containmt/narrow m-l so
L5650 0010 3 Additions to lower extremity, total contact, above knee or knee disarticulation socket Tot contact ak/knee disart s
L5651 0010 3 Addition to lower extremity, above knee, flexible inner socket, external frame Ak flex inner socket ext fra
L5652 0010 3 Addition to lower extremity, suction suspension, above knee or knee disarticulation socket Suction susp ak/knee disart
L5653 0010 3 Addition to lower extremity, knee disarticulation, expandable wall socket Knee disart expand wall sock
L5654 0010 3 Addition to lower extremity, socket insert, symes, (kemblo, pelite, aliplast, plastazote or equal) Socket insert symes
L5655 0010 3 Addition to lower extremity, socket insert, below knee (kemblo, pelite, aliplast, plastazote or equal) Socket insert below knee
L5656 0010 3 Addition to lower extremity, socket insert, knee disarticulation (kemblo, pelite, aliplast, plastazote or equal) Socket insert knee articulat
L5658 0010 3 Addition to lower extremity, socket insert, above knee (kemblo, pelite, aliplast, plastazote or equal) Socket insert above knee
L5661 0010 3 Addition to lower extremity, socket insert, multi-durometer symes Multi-durometer symes
L5665 0010 3 Addition to lower extremity, socket insert, multi-durometer, below knee Multi-durometer below knee
L5666 0010 3 Addition to lower extremity, below knee, cuff suspension Below knee cuff suspension
L5668 0010 3 Addition to lower extremity, below knee, molded distal cushion Bk molded distal cushion
L5670 0010 3 Addition to lower extremity, below knee, molded supracondylar suspension (‘pts’ or similar) Bk molded supracondylar susp
L5671 0010 3 Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert Bk/ak locking mechanism
L5672 0010 3 Addition to lower extremity, below knee, removable medial brim suspension Bk removable medial brim sus
L5673 0010 3 Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism Socket insert w lock mech
L5676 0010 3 Additions to lower extremity, below knee, knee joints, single axis, pair Bk knee joints single axis p
L5677 0010 3 Additions to lower extremity, below knee, knee joints, polycentric, pair Bk knee joints polycentric p
L5678 0010 3 Additions to lower extremity, below knee, joint covers, pair Bk joint covers pair
L5679 0010 3 Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism Socket insert w/o lock mech
L5680 0010 3 Addition to lower extremity, below knee, thigh lacer, nonmolded Bk thigh lacer non-molded
L5681 0010 3 Addition to lower extremity, below knee/above knee, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l5673 or l5679) Intl custm cong/latyp insert
L5682 0010 3 Addition to lower extremity, below knee, thigh lacer, gluteal/ischial, molded Bk thigh lacer glut/ischia m
L5683 0010 3 Addition to lower extremity, below knee/above knee, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l5673 or l5679) Initial custom socket insert
L5684 0010 3 Addition to lower extremity, below knee, fork strap Bk fork strap
L5685 0010 3 Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each Below knee sus/seal sleeve
L5686 0010 3 Addition to lower extremity, below knee, back check (extension control) Bk back check
L5688 0010 3 Addition to lower extremity, below knee, waist belt, webbing Bk waist belt webbing
L5690 0010 3 Addition to lower extremity, below knee, waist belt, padded and lined Bk waist belt padded and lin
L5692 0010 3 Addition to lower extremity, above knee, pelvic control belt, light Ak pelvic control belt light
L5694 0010 3 Addition to lower extremity, above knee, pelvic control belt, padded and lined Ak pelvic control belt pad/l
L5695 0010 3 Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each Ak sleeve susp neoprene/equa
L5696 0010 3 Addition to lower extremity, above knee or knee disarticulation, pelvic joint Ak/knee disartic pelvic join
L5697 0010 3 Addition to lower extremity, above knee or knee disarticulation, pelvic band Ak/knee disartic pelvic band
L5698 0010 3 Addition to lower extremity, above knee or knee disarticulation, silesian bandage Ak/knee disartic silesian ba
L5699 0010 3 All lower extremity prostheses, shoulder harness Shoulder harness
L5700 0010 3 Replacement, socket, below knee, molded to patient model Replace socket below knee
L5701 0010 3 Replacement, socket, above knee/knee disarticulation, including attachment plate, molded to patient model Replace socket above knee
L5702 0010 3 Replacement, socket, hip disarticulation, including hip joint, molded to patient model Replace socket hip
L5703 0010 3 Ankle, symes, molded to patient model, socket without solid ankle cushion heel (sach) foot, replacement only Symes ankle w/o (sach) foot
L5704 0010 3 Custom shaped protective cover, below knee Custom shape cover bk
L5705 0010 3 Custom shaped protective cover, above knee Custom shape cover ak
L5706 0010 3 Custom shaped protective cover, knee disarticulation Custom shape cvr knee disart
L5707 0010 3 Custom shaped protective cover, hip disarticulation Custom shape cvr hip disart
L5710 0010 3 Addition, exoskeletal knee-shin system, single axis, manual lock Kne-shin exo sng axi mnl loc
L5711 0010 3 Additions exoskeletal knee-shin system, single axis, manual lock, ultra-light material Knee-shin exo mnl lock ultra
L5712 0010 3 Addition, exoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee) Knee-shin exo frict swg & st
L5714 0010 3 Addition, exoskeletal knee-shin system, single axis, variable friction swing phase control Knee-shin exo variable frict
L5716 0010 3 Addition, exoskeletal knee-shin system, polycentric, mechanical stance phase lock Knee-shin exo mech stance ph
L5718 0010 3 Addition, exoskeletal knee-shin system, polycentric, friction swing and stance phase control Knee-shin exo frct swg & sta
L5722 0010 3 Addition, exoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control Knee-shin pneum swg frct exo
L5724 0010 3 Addition, exoskeletal knee-shin system, single axis, fluid swing phase control Knee-shin exo fluid swing ph
L5726 0010 3 Addition, exoskeletal knee-shin system, single axis, external joints fluid swing phase control Knee-shin ext jnts fld swg e
L5728 0010 3 Addition, exoskeletal knee-shin system, single axis, fluid swing and stance phase control Knee-shin fluid swg & stance
L5780 0010 3 Addition, exoskeletal knee-shin system, single axis, pneumatic/hydra pneumatic swing phase control Knee-shin pneum/hydra pneum
L5781 0010 3 Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system Lower limb pros vacuum pump
L5782 0010 3 Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy duty Hd low limb pros vacuum pump
L5785 0010 3 Addition, exoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) Exoskeletal bk ultralt mater
L5790 0010 3 Addition, exoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal) Exoskeletal ak ultra-light m
L5795 0010 3 Addition, exoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal) Exoskel hip ultra-light mate
L5810 0010 3 Addition, endoskeletal knee-shin system, single axis, manual lock Endoskel knee-shin mnl lock
L5811 0010 3 Addition, endoskeletal knee-shin system, single axis, manual lock, ultra-light material Endo knee-shin mnl lck ultra
L5812 0010 3 Addition, endoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee) Endo knee-shin frct swg & st
L5814 0010 3 Addition, endoskeletal knee-shin system, polycentric, hydraulic swing phase control, mechanical stance phase lock Endo knee-shin hydral swg ph
L5816 0010 3 Addition, endoskeletal knee-shin system, polycentric, mechanical stance phase lock Endo knee-shin polyc mch sta
L5818 0010 3 Addition, endoskeletal knee-shin system, polycentric, friction swing, and stance phase control Endo knee-shin frct swg & st
L5822 0010 3 Addition, endoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control Endo knee-shin pneum swg frc
L5824 0010 3 Addition, endoskeletal knee-shin system, single axis, fluid swing phase control Endo knee-shin fluid swing p
L5826 0010 3 Addition, endoskeletal knee-shin system, single axis, hydraulic swing phase control, with miniature high activity frame Miniature knee joint
L5828 0010 3 Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control Endo knee-shin fluid swg/sta
L5830 0010 3 Addition, endoskeletal knee-shin system, single axis, pneumatic/ swing phase control Endo knee-shin pneum/swg pha
L5840 0010 3 Addition, endoskeletal knee/shin system, 4-bar linkage or multiaxial, pneumatic swing phase control Multi-axial knee/shin system
L5845 0010 3 Addition, endoskeletal, knee-shin system, stance flexion feature, adjustable Knee-shin sys stance flexion
L5848 0010 3 Addition to endoskeletal knee-shin system, fluid stance extension, dampening feature, with or without adjustability Knee-shin sys hydraul stance
L5850 0010 3 Addition, endoskeletal system, above knee or hip disarticulation, knee extension assist Endo ak/hip knee extens assi
L5855 0010 3 Addition, endoskeletal system, hip disarticulation, mechanical hip extension assist Mech hip extension assist
L5856 0010 3 Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type Elec knee-shin swing/stance
L5857 0010 3 Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type Elec knee-shin swing only
L5858 0010 3 Addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type Stance phase only
L5859 0010 3 Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s) Knee-shin pro flex/ext cont
L5910 0010 3 Addition, endoskeletal system, below knee, alignable system Endo below knee alignable sy
L5920 0010 3 Addition, endoskeletal system, above knee or hip disarticulation, alignable system Endo ak/hip alignable system
L5925 0010 3 Addition, endoskeletal system, above knee, knee disarticulation or hip disarticulation, manual lock Above knee manual lock
L5930 0010 3 Addition, endoskeletal system, high activity knee control frame High activity knee frame
L5940 0010 3 Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) Endo bk ultra-light material
L5950 0010 3 Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal) Endo ak ultra-light material
L5960 0010 3 Addition, endoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal) Endo hip ultra-light materia
L5961 0010 3 Addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion and/or extension control Endo poly hip, pneu/hyd/rot
L5962 0010 3 Addition, endoskeletal system, below knee, flexible protective outer surface covering system Below knee flex cover system
L5964 0010 3 Addition, endoskeletal system, above knee, flexible protective outer surface covering system Above knee flex cover system
L5966 0010 3 Addition, endoskeletal system, hip disarticulation, flexible protective outer surface covering system Hip flexible cover system
L5968 0010 3 Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature Multiaxial ankle w dorsiflex
L5969 0010 3 Addition, endoskeletal ankle-foot or ankle system, power assist, includes any type motor(s) Ak/ft power asst incl motors
L5970 0010 3 All lower extremity prostheses, foot, external keel, sach foot Foot external keel sach foot
L5971 0010 3 All lower extremity prosthesis, solid ankle cushion heel (sach) foot, replacement only Sach foot, replacement
L5972 0010 3 All lower extremity prostheses, foot, flexible keel Flexible keel foot
L5973 0010 3 Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source Ank-foot sys dors-plant flex
L5974 0010 3 All lower extremity prostheses, foot, single axis ankle/foot Foot single axis ankle/foot
L5975 0010 3 All lower extremity prosthesis, combination single axis ankle and flexible keel foot Combo ankle/foot prosthesis
L5976 0010 3 All lower extremity prostheses, energy storing foot (seattle carbon copy ii or equal) Energy storing foot
L5978 0010 3 All lower extremity prostheses, foot, multiaxial ankle/foot Ft prosth multiaxial ankl/ft
L5979 0010 3 All lower extremity prosthesis, multi-axial ankle, dynamic response foot, one piece system Multi-axial ankle/ft prosth
L5980 0010 3 All lower extremity prostheses, flex foot system Flex foot system
L5981 0010 3 All lower extremity prostheses, flex-walk system or equal Flex-walk sys low ext prosth
L5982 0010 3 All exoskeletal lower extremity prostheses, axial rotation unit Exoskeletal axial rotation u
L5984 0010 3 All endoskeletal lower extremity prosthesis, axial rotation unit, with or without adjustability Endoskeletal axial rotation
L5985 0010 3 All endoskeletal lower extremity prostheses, dynamic prosthetic pylon Lwr ext dynamic prosth pylon
L5986 0010 3 All lower extremity prostheses, multi-axial rotation unit (‘mcp’ or equal) Multi-axial rotation unit
L5987 0010 3 All lower extremity prosthesis, shank foot system with vertical loading pylon Shank ft w vert load pylon
L5988 0010 3 Addition to lower limb prosthesis, vertical shock reducing pylon feature Vertical shock reducing pylo
L5990 0010 3 Addition to lower extremity prosthesis, user adjustable heel height User adjustable heel height
L5999 0010 3 Lower extremity prosthesis, not otherwise specified Lowr extremity prosthes nos
L6000 0010 3 Partial hand, thumb remaining Part hand thumb rem
L6010 0010 3 Partial hand, little and/or ring finger remaining Part hand little/ring
L6020 0010 3 Partial hand, no finger remaining Part hand no fingers
L6025 0010 3 Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectric control of terminal device Part hand disart myoelectric
L6026 0010 3 Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectric control of terminal device, excludes terminal device(s) Part hand myo exclu term dev
L6050 0010 3 Wrist disarticulation, molded socket, flexible elbow hinges, triceps pad Wrst mld sck flx hng tri pad
L6055 0010 3 Wrist disarticulation, molded socket with expandable interface, flexible elbow hinges, triceps pad Wrst mold sock w/exp interfa
L6100 0010 3 Below elbow, molded socket, flexible elbow hinge, triceps pad Elb mold sock flex hinge pad
L6110 0010 3 Below elbow, molded socket, (muenster or northwestern suspension types) Elbow mold sock suspension t
L6120 0010 3 Below elbow, molded double wall split socket, step-up hinges, half cuff Elbow mold doub splt soc ste
L6130 0010 3 Below elbow, molded double wall split socket, stump activated locking hinge, half cuff Elbow stump activated lock h
L6200 0010 3 Elbow disarticulation, molded socket, outside locking hinge, forearm Elbow mold outsid lock hinge
L6205 0010 3 Elbow disarticulation, molded socket with expandable interface, outside locking hinges, forearm Elbow molded w/ expand inter
L6250 0010 3 Above elbow, molded double wall socket, internal locking elbow, forearm Elbow inter loc elbow forarm
L6300 0010 3 Shoulder disarticulation, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm Shlder disart int lock elbow
L6310 0010 3 Shoulder disarticulation, passive restoration (complete prosthesis) Shoulder passive restor comp
L6320 0010 3 Shoulder disarticulation, passive restoration (shoulder cap only) Shoulder passive restor cap
L6350 0010 3 Interscapular thoracic, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm Thoracic intern lock elbow
L6360 0010 3 Interscapular thoracic, passive restoration (complete prosthesis) Thoracic passive restor comp
L6370 0010 3 Interscapular thoracic, passive restoration (shoulder cap only) Thoracic passive restor cap
L6380 0010 3 Immediate post surgical or early fitting, application of initial rigid dressing, including fitting alignment and suspension of components, and one cast change, wrist disarticulation or below elbow Postop dsg cast chg wrst/elb
L6382 0010 3 Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, elbow disarticulation or above elbow Postop dsg cast chg elb dis/
L6384 0010 3 Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, shoulder disarticulation or interscapular thoracic Postop dsg cast chg shlder/t
L6386 0010 3 Immediate post surgical or early fitting, each additional cast change and realignment Postop ea cast chg & realign
L6388 0010 3 Immediate post surgical or early fitting, application of rigid dressing only Postop applicat rigid dsg on
L6400 0010 3 Below elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping Below elbow prosth tiss shap
L6450 0010 3 Elbow disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping Elb disart prosth tiss shap
L6500 0010 3 Above elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping Above elbow prosth tiss shap
L6550 0010 3 Shoulder disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping Shldr disar prosth tiss shap
L6570 0010 3 Interscapular thoracic, molded socket, endoskeletal system, including soft prosthetic tissue shaping Scap thorac prosth tiss shap
L6580 0010 3 Preparatory, wrist disarticulation or below elbow, single wall plastic socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden cable control, usmc or equal pylon, no cover, molded to patient model Wrist/elbow bowden cable mol
L6582 0010 3 Preparatory, wrist disarticulation or below elbow, single wall socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden cable control, usmc or equal pylon, no cover, direct formed Wrist/elbow bowden cbl dir f
L6584 0010 3 Preparatory, elbow disarticulation or above elbow, single wall plastic socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or equal pylon, no cover, molded to patient model Elbow fair lead cable molded
L6586 0010 3 Preparatory, elbow disarticulation or above elbow, single wall socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or equal pylon, no cover, direct formed Elbow fair lead cable dir fo
L6588 0010 3 Preparatory, shoulder disarticulation or interscapular thoracic, single wall plastic socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, usmc or equal pylon, no cover, molded to patient model Shdr fair lead cable molded
L6590 0010 3 Preparatory, shoulder disarticulation or interscapular thoracic, single wall socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, usmc or equal pylon, no cover, direct formed Shdr fair lead cable direct
L6600 0010 3 Upper extremity additions, polycentric hinge, pair Polycentric hinge pair
L6605 0010 3 Upper extremity additions, single pivot hinge, pair Single pivot hinge pair
L6610 0010 3 Upper extremity additions, flexible metal hinge, pair Flexible metal hinge pair
L6611 0010 3 Addition to upper extremity prosthesis, external powered, additional switch, any type Additional switch, ext power
L6615 0010 3 Upper extremity addition, disconnect locking wrist unit Disconnect locking wrist uni
L6616 0010 3 Upper extremity addition, additional disconnect insert for locking wrist unit, each Disconnect insert locking wr
L6620 0010 3 Upper extremity addition, flexion/extension wrist unit, with or without friction Flexion/extension wrist unit
L6621 0010 3 Upper extremity prosthesis addition, flexion/extension wrist with or without friction, for use with external powered terminal device Flex/ext wrist w/wo friction
L6623 0010 3 Upper extremity addition, spring assisted rotational wrist unit with latch release Spring-ass rot wrst w/ latch
L6624 0010 3 Upper extremity addition, flexion/extension and rotation wrist unit Flex/ext/rotation wrist unit
L6625 0010 3 Upper extremity addition, rotation wrist unit with cable lock Rotation wrst w/ cable lock
L6628 0010 3 Upper extremity addition, quick disconnect hook adapter, otto bock or equal Quick disconn hook adapter o
L6629 0010 3 Upper extremity addition, quick disconnect lamination collar with coupling piece, otto bock or equal Lamination collar w/ couplin
L6630 0010 3 Upper extremity addition, stainless steel, any wrist Stainless steel any wrist
L6632 0010 3 Upper extremity addition, latex suspension sleeve, each Latex suspension sleeve each
L6635 0010 3 Upper extremity addition, lift assist for elbow Lift assist for elbow
L6637 0010 3 Upper extremity addition, nudge control elbow lock Nudge control elbow lock
L6638 0010 3 Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow Elec lock on manual pw elbow
L6640 0010 3 Upper extremity additions, shoulder abduction joint, pair Shoulder abduction joint pai
L6641 0010 3 Upper extremity addition, excursion amplifier, pulley type Excursion amplifier pulley t
L6642 0010 3 Upper extremity addition, excursion amplifier, lever type Excursion amplifier lever ty
L6645 0010 3 Upper extremity addition, shoulder flexion-abduction joint, each Shoulder flexion-abduction j
L6646 0010 3 Upper extremity addition, shoulder joint, multipositional locking, flexion, adjustable abduction friction control, for use with body powered or external powered system Multipo locking shoulder jnt
L6647 0010 3 Upper extremity addition, shoulder lock mechanism, body powered actuator Shoulder lock actuator
L6648 0010 3 Upper extremity addition, shoulder lock mechanism, external powered actuator Ext pwrd shlder lock/unlock
L6650 0010 3 Upper extremity addition, shoulder universal joint, each Shoulder universal joint
L6655 0010 3 Upper extremity addition, standard control cable, extra Standard control cable extra
L6660 0010 3 Upper extremity addition, heavy duty control cable Heavy duty control cable
L6665 0010 3 Upper extremity addition, teflon, or equal, cable lining Teflon or equal cable lining
L6670 0010 3 Upper extremity addition, hook to hand, cable adapter Hook to hand cable adapter
L6672 0010 3 Upper extremity addition, harness, chest or shoulder, saddle type Harness chest/shlder saddle
L6675 0010 3 Upper extremity addition, harness, (e.g., figure of eight type), single cable design Harness figure of 8 sing con
L6676 0010 3 Upper extremity addition, harness, (e.g., figure of eight type), dual cable design Harness figure of 8 dual con
L6677 0010 3 Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow Ue triple control harness
L6680 0010 3 Upper extremity addition, test socket, wrist disarticulation or below elbow Test sock wrist disart/bel e
L6682 0010 3 Upper extremity addition, test socket, elbow disarticulation or above elbow Test sock elbw disart/above
L6684 0010 3 Upper extremity addition, test socket, shoulder disarticulation or interscapular thoracic Test socket shldr disart/tho
L6686 0010 3 Upper extremity addition, suction socket Suction socket
L6687 0010 3 Upper extremity addition, frame type socket, below elbow or wrist disarticulation Frame typ socket bel elbow/w
L6688 0010 3 Upper extremity addition, frame type socket, above elbow or elbow disarticulation Frame typ sock above elb/dis
L6689 0010 3 Upper extremity addition, frame type socket, shoulder disarticulation Frame typ socket shoulder di
L6690 0010 3 Upper extremity addition, frame type socket, interscapular-thoracic Frame typ sock interscap-tho
L6691 0010 3 Upper extremity addition, removable insert, each Removable insert each
L6692 0010 3 Upper extremity addition, silicone gel insert or equal, each Silicone gel insert or equal
L6693 0010 3 Upper extremity addition, locking elbow, forearm counterbalance Lockingelbow forearm cntrbal
L6694 0010 3 Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism Elbow socket ins use w/lock
L6695 0010 3 Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism Elbow socket ins use w/o lck
L6696 0010 3 Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695) Cus elbo skt in for con/atyp
L6697 0010 3 Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695) Cus elbo skt in not con/atyp
L6698 0010 3 Addition to upper extremity prosthesis, below elbow/above elbow, lock mechanism, excludes socket insert Below/above elbow lock mech
L6703 0010 3 Terminal device, passive hand/mitt, any material, any size Term dev, passive hand mitt
L6704 0010 3 Terminal device, sport/recreational/work attachment, any material, any size Term dev, sport/rec/work att
L6706 0010 3 Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined Term dev mech hook vol open
L6707 0010 3 Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined Term dev mech hook vol close
L6708 0010 3 Terminal device, hand, mechanical, voluntary opening, any material, any size Term dev mech hand vol open
L6709 0010 3 Terminal device, hand, mechanical, voluntary closing, any material, any size Term dev mech hand vol close
L6711 0010 3 Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined, pediatric Ped term dev, hook, vol open
L6712 0010 3 Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined, pediatric Ped term dev, hook, vol clos
L6713 0010 3 Terminal device, hand, mechanical, voluntary opening, any material, any size, pediatric Ped term dev, hand, vol open
L6714 0010 3 Terminal device, hand, mechanical, voluntary closing, any material, any size, pediatric Ped term dev, hand, vol clos
L6715 0010 3 Terminal device, multiple articulating digit, includes motor(s), initial issue or replacement Term device, multi art digit
L6721 0010 3 Terminal device, hook or hand, heavy duty, mechanical, voluntary opening, any material, any size, lined or unlined Hook/hand, hvy dty, vol open
L6722 0010 3 Terminal device, hook or hand, heavy duty, mechanical, voluntary closing, any material, any size, lined or unlined Hook/hand, hvy dty, vol clos
L6805 0010 3 Addition to terminal device, modifier wrist unit Term dev modifier wrist unit
L6810 0010 3 Addition to terminal device, precision pinch device Term dev precision pinch dev
L6880 0010 3 Electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s) Elec hand ind art digits
L6881 0010 3 Automatic grasp feature, addition to upper limb electric prosthetic terminal device Term dev auto grasp feature
L6882 0010 3 Microprocessor control feature, addition to upper limb prosthetic terminal device Microprocessor control uplmb
L6883 0010 3 Replacement socket, below elbow/wrist disarticulation, molded to patient model, for use with or without external power Replc sockt below e/w disa
L6884 0010 3 Replacement socket, above elbow/elbow disarticulation, molded to patient model, for use with or without external power Replc sockt above elbow disa
L6885 0010 3 Replacement socket, shoulder disarticulation/interscapular thoracic, molded to patient model, for use with or without external power Replc sockt shldr dis/interc
L6890 0010 3 Addition to upper extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment Prefab glove for term device
L6895 0010 3 Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated Custom glove for term device
L6900 0010 3 Hand restoration (casts, shading and measurements included), partial hand, with glove, thumb or one finger remaining Hand restorat thumb/1 finger
L6905 0010 3 Hand restoration (casts, shading and measurements included), partial hand, with glove, multiple fingers remaining Hand restoration multiple fi
L6910 0010 3 Hand restoration (casts, shading and measurements included), partial hand, with glove, no fingers remaining Hand restoration no fingers
L6915 0010 3 Hand restoration (shading, and measurements included), replacement glove for above Hand restoration replacmnt g
L6920 0010 3 Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal, switch, cables, two batteries and one charger, switch control of terminal device Wrist disarticul switch ctrl
L6925 0010 3 Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device Wrist disart myoelectronic c
L6930 0010 3 Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device Below elbow switch control
L6935 0010 3 Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device Below elbow myoelectronic ct
L6940 0010 3 Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device Elbow disarticulation switch
L6945 0010 3 Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device Elbow disart myoelectronic c
L6950 0010 3 Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device Above elbow switch control
L6955 0010 3 Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device Above elbow myoelectronic ct
L6960 0010 3 Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device Shldr disartic switch contro
L6965 0010 3 Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device Shldr disartic myoelectronic
L6970 0010 3 Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device Interscapular-thor switch ct
L6975 0010 3 Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device Interscap-thor myoelectronic
L7007 0010 3 Electric hand, switch or myoelectric controlled, adult Adult electric hand
L7008 0010 3 Electric hand, switch or myoelectric, controlled, pediatric Pediatric electric hand
L7009 0010 3 Electric hook, switch or myoelectric controlled, adult Adult electric hook
L7040 0010 3 Prehensile actuator, switch controlled Prehensile actuator
L7045 0010 3 Electric hook, switch or myoelectric controlled, pediatric Pediatric electric hook
L7170 0010 3 Electronic elbow, hosmer or equal, switch controlled Electronic elbow hosmer swit
L7180 0010 3 Electronic elbow, microprocessor sequential control of elbow and terminal device Electronic elbow sequential
L7181 0010 3 Electronic elbow, microprocessor simultaneous control of elbow and terminal device Electronic elbo simultaneous
L7185 0010 3 Electronic elbow, adolescent, variety village or equal, switch controlled Electron elbow adolescent sw
L7186 0010 3 Electronic elbow, child, variety village or equal, switch controlled Electron elbow child switch
L7190 0010 3 Electronic elbow, adolescent, variety village or equal, myoelectronically controlled Elbow adolescent myoelectron
L7191 0010 3 Electronic elbow, child, variety village or equal, myoelectronically controlled Elbow child myoelectronic ct
L7259 0010 3 Electronic wrist rotator, any type Electronic wrist rotator any
L7260 0010 3 Electronic wrist rotator, otto bock or equal Electron wrist rotator otto
L7261 0010 3 Electronic wrist rotator, for utah arm Electron wrist rotator utah
L7360 0010 3 Six volt battery, each Six volt bat otto bock/eq ea
L7362 0010 3 Battery charger, six volt, each Battery chrgr six volt otto
L7364 0010 3 Twelve volt battery, each Twelve volt battery utah/equ
L7366 0010 3 Battery charger, twelve volt, each Battery chrgr 12 volt utah/e
L7367 0010 3 Lithium ion battery, rechargeable, replacement Replacemnt lithium ionbatter
L7368 0010 3 Lithium ion battery charger, replacement only Lithium ion battery charger
L7400 0010 3 Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultralight material (titanium, carbon fiber or equal) Add ue prost be/wd, ultlite
L7401 0010 3 Addition to upper extremity prosthesis, above elbow disarticulation, ultralight material (titanium, carbon fiber or equal) Add ue prost a/e ultlite mat
L7402 0010 3 Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultralight material (titanium, carbon fiber or equal) Add ue prost s/d ultlite mat
L7403 0010 3 Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material Add ue prost b/e acrylic
L7404 0010 3 Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material Add ue prost a/e acrylic
L7405 0010 3 Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material Add ue prost s/d acrylic
L7499 0010 3 Upper extremity prosthesis, not otherwise specified Upper extremity prosthes nos
L7510 0010 3 Repair of prosthetic device, repair or replace minor parts Prosthetic device repair rep
L7520 0010 3 Repair prosthetic device, labor component, per 15 minutes Repair prosthesis per 15 min
L7600 0010 3 Prosthetic donning sleeve, any material, each Prosthetic donning sleeve
L7700 0010 3 Gasket or seal, for use with prosthetic socket insert, any type, each Pros soc insert gasket/seal
L7900 0010 3 Male vacuum erection system Male vacuum erection system
L7902 0010 3 Tension ring, for vacuum erection device, any type, replacement only, each Tension ring, vac erect dev
L8000 0010 3 Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type Mastectomy bra
L8001 0010 3 Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type Breast prosthesis bra & form
L8002 0010 3 Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type Brst prsth bra & bilat form
L8010 0010 3 Breast prosthesis, mastectomy sleeve Mastectomy sleeve
L8015 0010 3 External breast prosthesis garment, with mastectomy form, post mastectomy Ext breastprosthesis garment
L8020 0010 3 Breast prosthesis, mastectomy form Mastectomy form
L8030 0010 3 Breast prosthesis, silicone or equal, without integral adhesive Breast prosthes w/o adhesive
L8031 0010 3 Breast prosthesis, silicone or equal, with integral adhesive Breast prosthesis w adhesive
L8032 0010 3 Nipple prosthesis, prefabricated, reusable, any type, each Reusable nipple prosthesis
L8033 0010 3 Nipple prosthesis, custom fabricated, reusable, any material, any type, each Nipple prosthesis custom, ea
L8035 0010 3 Custom breast prosthesis, post mastectomy, molded to patient model Custom breast prosthesis
L8039 0010 3 Breast prosthesis, not otherwise specified Breast prosthesis nos
L8040 0010 3 Nasal prosthesis, provided by a non-physician Nasal prosthesis
L8041 0010 3 Midfacial prosthesis, provided by a non-physician Midfacial prosthesis
L8042 0010 3 Orbital prosthesis, provided by a non-physician Orbital prosthesis
L8043 0010 3 Upper facial prosthesis, provided by a non-physician Upper facial prosthesis
L8044 0010 3 Hemi-facial prosthesis, provided by a non-physician Hemi-facial prosthesis
L8045 0010 3 Auricular prosthesis, provided by a non-physician Auricular prosthesis
L8046 0010 3 Partial facial prosthesis, provided by a non-physician Partial facial prosthesis
L8047 0010 3 Nasal septal prosthesis, provided by a non-physician Nasal septal prosthesis
L8048 0010 3 Unspecified maxillofacial prosthesis, by report, provided by a non-physician Unspec maxillofacial prosth
L8049 0010 3 Repair or modification of maxillofacial prosthesis, labor component, 15 minute increments, provided by a non-physician Repair maxillofacial prosth
L8300 0010 3 Truss, single with standard pad Truss single w/ standard pad
L8310 0010 3 Truss, double with standard pads Truss double w/ standard pad
L8320 0010 3 Truss, addition to standard pad, water pad Truss addition to std pad wa
L8330 0010 3 Truss, addition to standard pad, scrotal pad Truss add to std pad scrotal
L8400 0010 3 Prosthetic sheath, below knee, each Sheath below knee
L8410 0010 3 Prosthetic sheath, above knee, each Sheath above knee
L8415 0010 3 Prosthetic sheath, upper limb, each Sheath upper limb
L8417 0010 3 Prosthetic sheath/sock, including a gel cushion layer, below knee or above knee, each Pros sheath/sock w gel cushn
L8420 0010 3 Prosthetic sock, multiple ply, below knee, each Prosthetic sock multi ply bk
L8430 0010 3 Prosthetic sock, multiple ply, above knee, each Prosthetic sock multi ply ak
L8435 0010 3 Prosthetic sock, multiple ply, upper limb, each Pros sock multi ply upper lm
L8440 0010 3 Prosthetic shrinker, below knee, each Shrinker below knee
L8460 0010 3 Prosthetic shrinker, above knee, each Shrinker above knee
L8465 0010 3 Prosthetic shrinker, upper limb, each Shrinker upper limb
L8470 0010 3 Prosthetic sock, single ply, fitting, below knee, each Pros sock single ply bk
L8480 0010 3 Prosthetic sock, single ply, fitting, above knee, each Pros sock single ply ak
L8485 0010 3 Prosthetic sock, single ply, fitting, upper limb, each Pros sock single ply upper l
L8499 0010 3 Unlisted procedure for miscellaneous prosthetic services Unlisted misc prosthetic ser
L8500 0010 3 Artificial larynx, any type Artificial larynx
L8501 0010 3 Tracheostomy speaking valve Tracheostomy speaking valve
L8505 0010 3 Artificial larynx replacement battery / accessory, any type Artificial larynx, accessory
L8507 0010 3 Tracheo-esophageal voice prosthesis, patient inserted, any type, each Trach-esoph voice pros pt in
L8509 0010 3 Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type Trach-esoph voice pros md in
L8510 0010 3 Voice amplifier Voice amplifier
L8511 0010 3 Insert for indwelling tracheoesophageal prosthesis, with or without valve, replacement only, each Indwelling trach insert
L8512 0010 3 Gelatin capsules or equivalent, for use with tracheoesophageal voice prosthesis, replacement only, per 10 Gel cap for trach voice pros
L8513 0010 3 Cleaning device used with tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each Trach pros cleaning device
L8514 0010 3 Tracheoesophageal puncture dilator, replacement only, each Repl trach puncture dilator
L8515 0010 3 Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each Gel cap app device for trach
L8600 0010 3 Implantable breast prosthesis, silicone or equal Implant breast silicone/eq
L8603 0010 3 Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies Collagen imp urinary 2.5 ml
L8604 0010 3 Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, urinary tract, 1 ml, includes shipping and necessary supplies Dextranomer/hyaluronic acid
L8605 0010 3 Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, anal canal, 1 ml, includes shipping and necessary supplies Inj bulking agent anal canal
L8606 0010 3 Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe, includes shipping and necessary supplies Synthetic implnt urinary 1ml
L8607 0010 3 Injectable bulking agent for vocal cord medialization, 0.1 ml, includes shipping and necessary supplies Inj vocal cord bulking agent
L8608 0010 3 Miscellaneous external component, supply or accessory for use with the argus ii retinal prosthesis system Arg ii ext com/sup/acc misc
L8609 0010 3 Artificial cornea Artificial cornea
L8610 0010 3 Ocular implant Ocular implant
L8612 0010 3 Aqueous shunt Aqueous shunt prosthesis
L8613 0010 3 Ossicula implant Ossicular implant
L8614 0010 3 Cochlear device, includes all internal and external components Cochlear device
L8615 0010 3 Headset/headpiece for use with cochlear implant device, replacement Coch implant headset replace
L8616 0010 3 Microphone for use with cochlear implant device, replacement Coch implant microphone repl
L8617 0010 3 Transmitting coil for use with cochlear implant device, replacement Coch implant trans coil repl
L8618 0010 3 Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement Coch implant tran cable repl
L8619 0010 3 Cochlear implant, external speech processor and controller, integrated system, replacement Coch imp ext proc/contr rplc
L8621 0010 3 Zinc air battery for use with cochlear implant device and auditory osseointegrated sound processors, replacement, each Repl zinc air battery
L8622 0010 3 Alkaline battery for use with cochlear implant device, any size, replacement, each Repl alkaline battery
L8623 0010 3 Lithium ion battery for use with cochlear implant device speech processor, other than ear level, replacement, each Lith ion batt cid,non-earlvl
L8624 0010 3 Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement, each Lith ion batt cid, ear level
L8625 0010 3 External recharging system for battery for use with cochlear implant or auditory osseointegrated device, replacement only, each Charger coch impl/aoi battry
L8627 0010 3 Cochlear implant, external speech processor, component, replacement Cid ext speech process repl
L8628 0010 3 Cochlear implant, external controller component, replacement Cid ext controller repl
L8629 0010 3 Transmitting coil and cable, integrated, for use with cochlear implant device, replacement Cid transmit coil and cable
L8630 0010 3 Metacarpophalangeal joint implant Metacarpophalangeal implant
L8631 0010 3 Metacarpal phalangeal joint replacement, two or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon), for surgical implantation (all sizes, includes entire system) Mcp joint repl 2 pc or more
L8641 0010 3 Metatarsal joint implant Metatarsal joint implant
L8642 0010 3 Hallux implant Hallux implant
L8658 0010 3 Interphalangeal joint spacer, silicone or equal, each Interphalangeal joint spacer
L8659 0010 3 Interphalangeal finger joint replacement, 2 or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon) for surgical implantation, any size Interphalangeal joint repl
L8670 0010 3 Vascular graft material, synthetic, implant Vascular graft, synthetic
L8679 0010 3 Implantable neurostimulator, pulse generator, any type Imp neurosti pls gn any type
L8680 0010 3 Implantable neurostimulator electrode, each Implt neurostim elctr each
L8681 0010 3 Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only Pt prgrm for implt neurostim
L8682 0010 3 Implantable neurostimulator radiofrequency receiver Implt neurostim radiofq rec
L8683 0010 3 Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver Radiofq trsmtr for implt neu
L8684 0010 3 Radiofrequency transmitter (external) for use with implantable sacral root neurostimulator receiver for bowel and bladder management, replacement Radiof trsmtr implt scrl neu
L8685 0010 3 Implantable neurostimulator pulse generator, single array, rechargeable, includes extension Implt nrostm pls gen sng rec
L8686 0010 3 Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension Implt nrostm pls gen sng non
L8687 0010 3 Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension Implt nrostm pls gen dua rec
L8688 0010 3 Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension Implt nrostm pls gen dua non
L8689 0010 3 External recharging system for battery (internal) for use with implantable neurostimulator, replacement only External recharg sys intern
L8690 0010 3 Auditory osseointegrated device, includes all internal and external components Aud osseo dev, int/ext comp
L8691 0010 3 Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each Aoi snd proc repl excl actua
L8692 0010 3 Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment Non-osseointegrated snd proc
L8693 0010 3 Auditory osseointegrated device abutment, any length, replacement only Aud osseo dev, abutment
L8694 0010 3 Auditory osseointegrated device, transducer/actuator, replacement only, each Aoi transducer/actuator repl
L8695 0010 3 External recharging system for battery (external) for use with implantable neurostimulator, replacement only External recharg sys extern
L8696 0010 3 Antenna (external) for use with implantable diaphragmatic/phrenic nerve stimulation device, replacement, each Ext antenna phren nerve stim
L8698 0010 3 Miscellaneous component, supply or accessory for use with total artificial heart system Misc used with tot art heart
L8699 0010 3 Prosthetic implant, not otherwise specified Prosthetic implant nos
L8701 0010 3 Powered upper extremity range of motion assist device, elbow, wrist, hand with single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated Pow ue rom dev ewh uprt cust
L8702 0010 3 Powered upper extremity range of motion assist device, elbow, wrist, hand, finger, single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated Pow ue rom dev ewhf uprt cus
L9900 0010 3 Orthotic and prosthetic supply, accessory, and/or service component of another hcpcs “l” code O&p supply/accessory/service