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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• L3905

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

• L3906

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

• L3908

  Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf

• L3912

  Hand finger orthosis (hfo), flexion glove with elastic finger control, prefabricated, off-the-shelf

• L3913

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

• L3915

  Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

• L3916

  Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf

• L3917

  Hand orthosis, metacarpal fracture orthosis, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

• L3918

  Hand orthosis, metacarpal fracture orthosis, prefabricated, off-the-shelf

• L3919

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

• L3921

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

• L3923

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

• L3924

  Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, off-the-shelf

• L3925

  Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf

• L3927

  Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), without joint/spring, extension/flexion (e.g., static or ring type), may include soft interface material, prefabricated, off-the-shelf

• L3929

  Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

• L3930

  Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, off-the-shelf

• L3931

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

• L3933

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

• L3935

  Finger orthosis, nontorsion joint, may include soft interface, custom fabricated, includes fitting and adjustment

• L3956

  Addition of joint to upper extremity orthosis, any material; per joint

• L3960

  Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment

• L3961

  Shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

• L3962

  Shoulder elbow wrist hand orthosis, abduction positioning, erb's palsey design, prefabricated, includes fitting and adjustment

• L3967

  Shoulder elbow wrist hand orthosis, abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

• L3971

  Shoulder elbow wrist hand orthosis, shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

• L3973

  Shoulder elbow wrist hand orthosis, abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

• L3975

  Shoulder elbow wrist hand finger orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

• L3976

  Shoulder elbow wrist hand finger orthosis, abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

• L3977

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

• L3978

  Shoulder elbow wrist hand finger orthosis, abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

• L3980

  Upper extremity fracture orthosis, humeral, prefabricated, includes fitting and adjustment

• L3981

  Upper extremity fracture orthosis, humeral, prefabricated, includes shoulder cap design, with or without joints, forearm section, may include soft interface, straps, includes fitting and adjustments

• L3982

  Upper extremity fracture orthosis, radius/ulnar, prefabricated, includes fitting and adjustment

• L3984

  Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment

• L3995

  Addition to upper extremity orthosis, sock, fracture or equal, each

• L3999

  Upper limb orthosis, not otherwise specified

• L4000

  Replace girdle for spinal orthosis (ctlso or so)

• L4002

  Replacement strap, any orthosis, includes all components, any length, any type

• L4010

  Replace trilateral socket brim

• L4020

  Replace quadrilateral socket brim, molded to patient model

• L4030

  Replace quadrilateral socket brim, custom fitted

• L4040

  Replace molded thigh lacer, for custom fabricated orthosis only

• L4045

  Replace non-molded thigh lacer, for custom fabricated orthosis only

• L4050

  Replace molded calf lacer, for custom fabricated orthosis only

• L4055

  Replace non-molded calf lacer, for custom fabricated orthosis only

• L4060

  Replace high roll cuff

• L4070

  Replace proximal and distal upright for kafo

• L4080

  Replace metal bands kafo, proximal thigh

• L4090

  Replace metal bands kafo-afo, calf or distal thigh

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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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