Reference
HCPCS L codes (orthotics + prosthetics)
123 L codes for braces, orthoses, and prostheses.
Codes indexed
123
Diabetic shoes
| Code | Description |
|---|---|
| A5500 | For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
| A5501 | For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoe |
| A5512 | For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees Fahrenheit or higher |
| A5513 | For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot |
LE orthotic
| Code | Description |
|---|---|
| L1810 | Knee orthosis (KO), elastic with joints, prefabricated, off-the-shelf |
| L1812 | Knee orthosis (KO), elastic with joints, prefabricated, includes fitting and adjustment |
| L1820 | Knee orthosis (KO), elastic with condylar pads and joints, with or without patellar control, prefabricated |
| L1830 | Knee orthosis (KO), immobilizer, canvas longitudinal, prefabricated |
| L1832 | Knee orthosis (KO), adjustable knee joints, positional orthosis, rigid support, prefabricated |
| L1833 | Knee orthosis (KO), adjustable knee joints, positional orthosis, rigid support, prefabricated, off-the-shelf |
| L1834 | Knee orthosis (KO), without knee joint, rigid, custom fabricated |
| L1836 | Knee orthosis (KO), rigid, without joint(s), prefabricated |
| L1843 | Knee orthosis (KO), single upright, thigh and calf, with adjustable flexion and extension joint, prefabricated |
| L1844 | Knee orthosis (KO), single upright, thigh and calf, with adjustable flexion and extension joint, custom fabricated |
| L1845 | Knee orthosis (KO), double upright, thigh and calf, with adjustable flexion and extension joint, prefabricated |
| L1846 | Knee orthosis (KO), double upright, thigh and calf, with adjustable flexion and extension joint, custom fabricated |
| L1847 | Knee orthosis (KO), double upright with adjustable joint, with inflatable air support chamber(s) |
| L1851 | Knee orthosis (KO), single upright, thigh and calf, with adjustable flexion and extension joint, medial-lateral and rotation control, prefabricated, off-the-shelf |
| L1852 | Knee orthosis (KO), double upright, thigh and calf, with adjustable flexion and extension joint, medial-lateral and rotation control, prefabricated, off-the-shelf |
| L1900 | Ankle foot orthosis (AFO), spring wire, dorsiflexion assist |
| L1902 | Ankle foot orthosis (AFO), ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
| L1904 | Ankle foot orthosis (AFO), molded ankle gauntlet, custom-fabricated |
| L1906 | Ankle foot orthosis (AFO), multiligamentous ankle support, prefabricated, off-the-shelf |
| L1907 | Ankle orthosis (AO), supramalleolar with straps, with or without interface/pads, custom fabricated |
| L1910 | Ankle foot orthosis (AFO), posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment |
| L1920 | Ankle foot orthosis (AFO), single upright with static or adjustable stop |
| L1930 | Ankle foot orthosis (AFO), plastic or other material, prefabricated, off-the-shelf |
| L1932 | Ankle foot orthosis (AFO), rigid anterior tibial section, total carbon fiber or equal material, prefabricated, off-the-shelf |
| L1940 | Ankle foot orthosis (AFO), plastic or other material, custom fabricated |
| L1945 | Ankle foot orthosis (AFO), plastic, rigid anterior tibial section, custom fabricated |
| L1950 | Ankle foot orthosis (AFO), spiral, plastic or other material, custom fabricated |
| L1960 | Ankle foot orthosis (AFO), posterior solid ankle, plastic, custom fabricated |
| L1970 | Ankle foot orthosis (AFO), plastic, articulating ankle, custom fabricated |
| L1980 | Ankle foot orthosis (AFO), single upright free plantar dorsiflexion, solid stirrup, calf band/cuff |
| L1990 | Ankle foot orthosis (AFO), double upright free plantar dorsiflexion, solid stirrup, calf band/cuff |
| L2000 | Knee ankle foot orthosis (KAFO), single upright, free knee, free ankle, solid stirrup, thigh and calf bands/cuffs |
| L2005 | Knee ankle foot orthosis (KAFO), any material, single or double upright, stance control, automatic lock and swing phase release, mechanical activation, includes ankle joint, any type, custom fabricated |
| L2020 | Knee ankle foot orthosis (KAFO), double upright, free ankle, solid stirrup, thigh and calf bands/cuffs |
| L2030 | Knee ankle foot orthosis (KAFO), double upright, free ankle, solid stirrup, thigh and calf bands/cuffs, knee/ankle joint, drop lock knee joint |
| L2034 | Knee ankle foot orthosis (KAFO), full plastic, single upright, with or without free motion knee, medial lateral rotation control, custom fabricated |
| L2036 | Knee ankle foot orthosis (KAFO), full plastic, double upright, with or without free motion knee, custom fabricated |
| L2037 | Knee ankle foot orthosis (KAFO), full plastic, single upright, custom fabricated |
| L2038 | Knee ankle foot orthosis (KAFO), full plastic, with or without free motion knee, multi-axis ankle, custom fabricated |
| L2040 | Hip knee ankle foot orthosis (HKAFO), torsion control, bilateral rotation straps, pelvic band/belt |
| L2050 | Hip knee ankle foot orthosis (HKAFO), torsion control, bilateral torsion cables, hip joint, pelvic band/belt |
Prosthetic
| Code | Description |
|---|---|
| L5000 | Partial foot, shoe insert with longitudinal arch, toe filler |
| L5010 | Partial foot, molded socket, ankle height, with toe filler |
| L5020 | Partial foot, molded socket, tibial tubercle height, with toe filler |
| L5050 | Ankle, Symes, molded socket, SACH foot |
| L5060 | Ankle, Symes, metal frame, molded leather socket, articulated ankle/foot |
| L5100 | Below knee, molded socket, shin, SACH foot |
| L5105 | Below knee, plastic socket, joints and thigh lacer, SACH foot |
| L5150 | Knee disarticulation (or through knee), molded socket, external knee joints, shin, SACH foot |
| L5200 | Above knee, molded socket, single axis constant friction knee, shin, SACH foot |
| L5210 | Above knee, short prosthesis, no knee joint (stubbies), with foot blocks, no ankle joints |
| L5220 | Above knee, short prosthesis, no knee joint (stubbies), with articulated ankle/foot, dynamically aligned |
| L5230 | Above knee, for proximal femoral focal deficiency, constant friction knee, shin, SACH foot |
| L5250 | Hip disarticulation, Canadian type, molded socket, hip joint, single axis constant friction knee, shin, SACH foot |
| L5270 | Hemipelvectomy, Canadian type, molded socket, hip joint, single axis constant friction knee, shin, SACH foot |
Spinal
| Code | Description |
|---|---|
| L0140 | Cervical, semi-rigid, adjustable (plastic collar) |
| L0150 | Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibular/occipital piece) |
| L0160 | Cervical, semi-rigid, wire frame occipital/mandibular support |
| L0170 | Cervical, collar, molded to patient model |
| L0180 | Cervical, multiple post collar, occipital/mandibular supports, adjustable |
| L0190 | Cervical, multiple post collar, cervical thoracic, occipital/mandibular supports |
| L0200 | Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars |
| L0450 | TLSO, flexible |
| L0454 | TLSO sagittal control, prefabricated, custom fitted |
| L0456 | TLSO sagittal-coronal control, prefab off-the-shelf |
| L0457 | TLSO sagittal-coronal control, custom fitted |
| L0458 | TLSO triplanar control, prefabricated, off-the-shelf |
| L0464 | TLSO triplanar control, prefabricated, custom fitted |
| L0466 | TLSO sagittal control, rigid, custom-fitted |
| L0468 | TLSO sagittal-coronal control, rigid, custom-fitted |
| L0469 | TLSO triplanar control, rigid, custom-fitted |
| L0480 | TLSO triplanar control, one piece rigid plastic shell |
| L0490 | TLSO triplanar control, two-piece rigid plastic shell |
| L0625 | Lumbar orthosis, flexible |
| L0626 | Lumbosacral orthosis, sagittal control |
| L0627 | Lumbosacral orthosis, sagittal-coronal control |
| L0628 | Lumbosacral orthosis, sagittal control, custom-fitted |
| L0630 | Lumbosacral orthosis, sagittal-coronal control, custom-fitted |
| L0631 | Lumbosacral orthosis, sagittal-coronal control, with rigid posterior panel |
| L0633 | Lumbosacral orthosis, sagittal-coronal control with rigid posterior panel custom-fitted |
| L0635 | Lumbosacral orthosis, sagittal-coronal control with rigid posterior frame/panel custom fabricated |
| L0637 | Lumbosacral orthosis, sagittal-coronal control with rigid anterior, posterior, lateral panels custom-fitted |
| L0639 | Lumbosacral orthosis triplanar control, custom fabricated |
| L0648 | Lumbar-sacral orthosis (LSO), flexible, custom-fabricated, includes fitting and adjustment |
| L0650 | Lumbar-sacral orthosis (LSO), sagittal-coronal control, custom-fabricated |
| L0700 | Cervical-thoracic-lumbar-sacral orthosis (CTLSO) |
| L0710 | CTLSO, anterior-posterior, infant, child or adult, prefabricated, includes fitting and adjustment |
| L0810 | Halo procedure, cervical halo incorporated into jacket vest |
| L0820 | Halo procedure, cervical halo incorporated into plaster body jacket |
| L0830 | Halo procedure, cervical halo incorporated into Milwaukee type orthosis |
Spinal/SI
| Code | Description |
|---|---|
| L0980 | Pelvic sacroiliac belt, flexible, includes any type of pelvic belt with insert |
UE orthotic
| Code | Description |
|---|---|
| L3650 | Shoulder orthosis (SO), figure of eight design abduction restrainer, prefabricated, off-the-shelf |
| L3660 | Shoulder orthosis (SO), figure of eight design abduction restrainer, canvas and webbing, prefabricated, includes fitting and adjustment |
| L3670 | Shoulder orthosis (SO), acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
| L3675 | Shoulder orthosis (SO), vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf |
| L3677 | Shoulder orthosis (SO), shoulder joint design, without joints |
| L3702 | Elbow orthosis (EO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| L3710 | Elbow orthosis (EO), elastic with stays, prefabricated, off-the-shelf |
| L3720 | Elbow orthosis (EO), double upright with forearm/arm cuffs, free motion |
| L3730 | Elbow orthosis (EO), double upright with forearm/arm cuffs, extension/flexion assist |
| L3740 | Elbow orthosis (EO), double upright with forearm/arm cuffs, adjustable position lock with active control |
| L3760 | Elbow orthosis (EO), with adjustable position locking joint, custom fabricated |
| L3762 | Elbow orthosis (EO), rigid, without joints, custom fabricated |
| L3763 | Elbow wrist hand orthosis (EWHO), rigid, without joints, custom fabricated |
| L3764 | Elbow wrist hand orthosis (EWHO), includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, custom fabricated |
| L3765 | Elbow wrist hand finger orthosis (EWHFO), rigid, without joints, custom fabricated |
| L3766 | Elbow wrist hand finger orthosis (EWHFO), includes one or more nontorsion joints, elastic bands, turnbuckles, custom fabricated |
| L3807 | Wrist hand finger orthosis (WHFO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| L3808 | Wrist hand finger orthosis (WHFO), rigid without joints, with or without joints, may include soft interface material, with fitting |
| L3809 | Wrist hand finger orthosis (WHFO), without joints, may include soft interface, straps, prefabricated, off-the-shelf |
| L3914 | Wrist hand orthosis (WHO), includes one or more nontorsion joints, elastic bands, turnbuckles, prefabricated, off-the-shelf |
| L3916 | Wrist hand orthosis (WHO), includes one or more joints, elastic bands, turnbuckles, custom fabricated |
| L3923 | Hand finger orthosis (HFO), without joints, may include soft interface, prefabricated, off-the-shelf |
| L3924 | Hand finger orthosis (HFO), without joints, may include soft interface, straps, custom fabricated |
| L3925 | Finger orthosis, proximal interphalangeal (PIP)/distal interphalangeal (DIP), nontorsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf |
| L3926 | Hand orthosis (HO), nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, custom fabricated |
| L3927 | Finger orthosis, proximal interphalangeal (PIP)/distal interphalangeal (DIP), without joint/spring, may include soft interface, prefabricated, off-the-shelf |
| L3929 | Hand finger orthosis (HFO), includes joint(s), turnbuckles, elastic bands, may include soft interface, straps, prefabricated, off-the-shelf |
| L3930 | Hand finger orthosis (HFO), includes joint(s), turnbuckles, elastic bands, custom fabricated |
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