HCPCS Codes for Lump sum purchase of DME, prosthetics, orthotics


  • 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
  • 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