Braces; trusses; and artifical legs, arms, and eyes are covered when furnished incident to a physician’s services or on a physician’s order. A brace includes rigid and semirigid devices used for the purpose of supporting a weak or deformed body member or restricting or eliminating motion in a diseased or injured part of the body. Back braces include, but are not limited to, sacroiliac, sacrolumbar, dorsolumbar corsets, and belts. Stump stockings and harnesses (including replacements) are also covered when these appliances are essential to the effective use of an artificial limb. Adjustments to an artificial limb or other appliance required by wear or by a change in the patient’s condition are covered when ordered by a physician. Adjustments, repairs, and replacements are covered so long as the device continues to be medically required.

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• L3460

  Heel, new rubber, standard

• L3465

  Heel, thomas with wedge

• L3470

  Heel, thomas extended to ball

• L3480

  Heel, pad and depression for spur

• L3485

  Heel, pad, removable for spur

• L3500

  Orthopedic shoe addition, insole, leather

• L3510

  Orthopedic shoe addition, insole, rubber

• L3520

  Orthopedic shoe addition, insole, felt covered with leather

• L3530

  Orthopedic shoe addition, sole, half

• L3540

  Orthopedic shoe addition, sole, full

• L3550

  Orthopedic shoe addition, toe tap standard

• L3560

  Orthopedic shoe addition, toe tap, horseshoe

• L3570

  Orthopedic shoe addition, special extension to instep (leather with eyelets)

• L3580

  Orthopedic shoe addition, convert instep to velcro closure

• L3590

  Orthopedic shoe addition, convert firm shoe counter to soft counter

• L3595

  Orthopedic shoe addition, march bar

• L3600

  Transfer of an orthosis from one shoe to another, caliper plate, existing

• L3610

  Transfer of an orthosis from one shoe to another, caliper plate, new

• L3620

  Transfer of an orthosis from one shoe to another, solid stirrup, existing

• L3630

  Transfer of an orthosis from one shoe to another, solid stirrup, new

• L3640

  Transfer of an orthosis from one shoe to another, dennis browne splint (riveton), both shoes

• L3649

  Orthopedic shoe, modification, addition or transfer, not otherwise specified

• L3650

  Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf

• L3660

  Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf

• L3670

  Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf

• L3671

  Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

• L3674

  Shoulder orthosis, abduction positioning (airplane design), thoracic component and support bar, with or without nontorsion joint/turnbuckle, may include soft interface, straps, custom fabricated, includes fitting and adjustment

• L3675

  Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf

• L3677

  Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

• L3678

  Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated, off-the-shelf

• L3702

  Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

• L3710

  Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf

• L3720

  Elbow orthosis, double upright with forearm/arm cuffs, free motion, custom fabricated

• L3730

  Elbow orthosis, double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated

• L3740

  Elbow orthosis, double upright with forearm/arm cuffs, adjustable position lock with active control, custom fabricated

• L3760

  Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

• L3761

  Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, off-the-shelf

• L3762

  Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf

• L3763

  Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

• L3764

  Elbow wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

• L3765

  Elbow wrist hand finger orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

• L3766

  Elbow wrist hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

• L3806

  Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment

• L3807

  Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

• L3808

  Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment

• L3809

  Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type

• L3891

  Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each

• L3900

  Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, wrist or finger driven, custom fabricated

• L3901

  Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom fabricated

• L3904

  Wrist hand finger orthosis, external powered, electric, custom fabricated

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HCPCS Level II codes and descriptors are approved and maintained jointly by the alpha-numeric editorial panel (consisting of CMS, the Health Insurance Association of America, and the Blue Cross and Blue Shield Association). — Updated 6/3/2026

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