HCPCS L-Codes
Orthotic and Prosthetic Procedures, Devices

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.

  • L4100

    Replace leather cuff kafo, proximal thigh

  • L4110

    Replace leather cuff kafo-afo, calf or distal thigh

  • L4130

    Replace pretibial shell

  • L4205

    Repair of orthotic device, labor component, per 15 minutes

  • L4210

    Repair of orthotic device, repair or replace minor parts

  • L4350

    Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf

  • L4360

    Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

  • L4361

    Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf

  • L4370

    Pneumatic full leg splint, prefabricated, off-the-shelf

  • L4386

    Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
  • Continued

  • L4387

    Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf

  • L4392

    Replacement, soft interface material, static afo

  • L4394

    Replace soft interface material, foot drop splint

  • L4396

    Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

  • L4397

    Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf

  • L4398

    Foot drop splint, recumbent positioning device, prefabricated, off-the-shelf

  • L4631

    Ankle foot orthosis, walking boot type, varus/valgus correction, rocker bottom, anterior tibial shell, soft interface, custom arch support, plastic or other material, includes straps and closures, custom fabricated

  • 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

  • L5160

    Knee disarticulation (or through knee), molded socket, bent knee configuration, 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, each

  • L5220

    Above knee, short prosthesis, no knee joint ('stubbies'), with articulated ankle/foot, dynamically aligned, each

  • L5230

    Above knee, for proximal femoral focal deficiency, constant friction knee, shin, sach foot
  • Continued

  • L5250

    Hip disarticulation, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot

  • L5270

    Hip disarticulation, tilt table type; molded socket, locking hip joint, single axis constant friction knee, shin, sach foot

  • L5280

    Hemipelvectomy, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot

  • L5301

    Below knee, molded socket, shin, sach foot, endoskeletal system

  • L5312

    Knee disarticulation (or through knee), molded socket, single axis knee, pylon, sach foot, endoskeletal system

  • L5321

    Above knee, molded socket, open end, sach foot, endoskeletal system, single axis knee

  • L5331

    Hip disarticulation, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot

  • L5341

    Hemipelvectomy, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot

  • L5400

    Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment, suspension, and one cast change, below knee

  • L5410

    Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension, below knee, each additional cast change and realignment

  • L5420

    Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension and one cast change 'ak' or knee disarticulation

  • L5430

    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

  • L5450

    Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, below knee

  • L5460

    Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, above knee

  • L5500

    Initial, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed

  • L5505

    Initial, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed

  • L5510

    Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model

  • L5520

    Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed

  • L5530

    Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model

  • L5535

    Preparatory, below knee 'ptb' type socket, non-alignable system, no cover, sach foot, prefabricated, adjustable open end socket