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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
BackL3000Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each→L3001Foot, insert, removable, molded to patient model, spenco, each→L3002Foot, insert, removable, molded to patient model, plastazote or equal, each→L3003Foot, insert, removable, molded to patient model, silicone gel, each→L3010Foot, insert, removable, molded to patient model, longitudinal arch support, each→L3020Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each→L3030Foot, insert, removable, formed to patient foot, each→L3031Foot, insert/plate, removable, addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, each→L3040Foot, arch support, removable, premolded, longitudinal, each→L3050Foot, arch support, removable, premolded, metatarsal, each→L3060Foot, arch support, removable, premolded, longitudinal/ metatarsal, each→L3070Foot, arch support, non-removable attached to shoe, longitudinal, each→L3080Foot, arch support, non-removable attached to shoe, metatarsal, each→L3090Foot, arch support, non-removable attached to shoe, longitudinal/metatarsal, each→L3100Hallus-valgus night dynamic splint, prefabricated, off-the-shelf→L3140Foot, abduction rotation bar, including shoes→L3150Foot, abduction rotation bar, without shoes→L3160Foot, adjustable shoe-styled positioning device→L3161Foot, adductus positioning device, adjustable→L3170Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each→L3201Orthopedic shoe, oxford with supinator or pronator, infant→L3202Orthopedic shoe, oxford with supinator or pronator, child→L3203Orthopedic shoe, oxford with supinator or pronator, junior→L3204Orthopedic shoe, hightop with supinator or pronator, infant→L3206Orthopedic shoe, hightop with supinator or pronator, child→L3207Orthopedic shoe, hightop with supinator or pronator, junior→L3208Surgical boot, each, infant→L3209Surgical boot, each, child→L3211Surgical boot, each, junior→L3212Benesch boot, pair, infant→L3213Benesch boot, pair, child→L3214Benesch boot, pair, junior→L3215Orthopedic footwear, ladies shoe, oxford, each→L3216Orthopedic footwear, ladies shoe, depth inlay, each→L3217Orthopedic footwear, ladies shoe, hightop, depth inlay, each→L3219Orthopedic footwear, mens shoe, oxford, each→L3221Orthopedic footwear, mens shoe, depth inlay, each→L3222Orthopedic footwear, mens shoe, hightop, depth inlay, each→L3224Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthosis)→L3225Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis)→L3230Orthopedic footwear, custom shoe, depth inlay, each→L3250Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each→L3251Foot, shoe molded to patient model, silicone shoe, each→L3252Foot, shoe molded to patient model, plastazote (or similar), custom fabricated, each→L3253Foot, molded shoe plastazote (or similar) custom fitted, each→L3254Non-standard size or width→L3255Non-standard size or length→L3257Orthopedic footwear, additional charge for split size→L3260Surgical boot/shoe, each→L3265Plastazote sandal, each→L3300Lift, elevation, heel, tapered to metatarsals, per inch→L3310Lift, elevation, heel and sole, neoprene, per inch→L3320Lift, elevation, heel and sole, cork, per inch→L3330Lift, elevation, metal extension (skate)→L3332Lift, elevation, inside shoe, tapered, up to one-half inch→L3334Lift, elevation, heel, per inch→L3340Heel wedge, sach→L3350Heel wedge→L3360Sole wedge, outside sole→L3370Sole wedge, between sole→L3380Clubfoot wedge→L3390Outflare wedge→L3400Metatarsal bar wedge, rocker→L3410Metatarsal bar wedge, between sole→L3420Full sole and heel wedge, between sole→L3430Heel, counter, plastic reinforced→L3440Heel, counter, leather reinforced→L3450Heel, sach cushion type→L3455Heel, new leather, standard→L3460Heel, new rubber, standard→L3465Heel, thomas with wedge→L3470Heel, thomas extended to ball→L3480Heel, pad and depression for spur→L3485Heel, pad, removable for spur→L3500Orthopedic shoe addition, insole, leather→L3510Orthopedic shoe addition, insole, rubber→L3520Orthopedic shoe addition, insole, felt covered with leather→L3530Orthopedic shoe addition, sole, half→L3540Orthopedic shoe addition, sole, full→L3550Orthopedic shoe addition, toe tap standard→L3560Orthopedic shoe addition, toe tap, horseshoe→L3570Orthopedic shoe addition, special extension to instep (leather with eyelets)→L3580Orthopedic shoe addition, convert instep to velcro closure→L3590Orthopedic shoe addition, convert firm shoe counter to soft counter→L3595Orthopedic shoe addition, march bar→L3600Transfer of an orthosis from one shoe to another, caliper plate, existing→L3610Transfer of an orthosis from one shoe to another, caliper plate, new→L3620Transfer of an orthosis from one shoe to another, solid stirrup, existing→L3630Transfer of an orthosis from one shoe to another, solid stirrup, new→L3640Transfer of an orthosis from one shoe to another, dennis browne splint (riveton), both shoes→L3649Orthopedic shoe, modification, addition or transfer, not otherwise specified→L3650Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf→L3660Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf→L3670Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf→L3671Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment→L3674Shoulder 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→L3675Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf→L3677Shoulder 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→L3678Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated, off-the-shelf→L3702Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment→L3710Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf→L3720Elbow orthosis, double upright with forearm/arm cuffs, free motion, custom fabricated→L3730Elbow orthosis, double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated→L3740Elbow orthosis, double upright with forearm/arm cuffs, adjustable position lock with active control, custom fabricated→L3760Elbow 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→L3761Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, off-the-shelf→L3762Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf→L3763Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment→L3764Elbow wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment→L3765Elbow wrist hand finger orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment→L3766Elbow wrist hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment→L3806Wrist 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→L3807Wrist 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→L3808Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment→L3809Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type→L3891Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each→L3900Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, wrist or finger driven, custom fabricated→L3901Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom fabricated→L3904Wrist hand finger orthosis, external powered, electric, custom fabricated→L3905Wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment→L3906Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment→L3908Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf→L3912Hand finger orthosis (hfo), flexion glove with elastic finger control, prefabricated, off-the-shelf→L3913Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment→L3915Wrist 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→L3916Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf→L3917Hand 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→L3918Hand orthosis, metacarpal fracture orthosis, prefabricated, off-the-shelf→L3919Hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment→L3921Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment→L3923Hand 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→L3924Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, off-the-shelf→L3925Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf→L3927Finger 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→L3929Hand 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→L3930Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, off-the-shelf→L3931Wrist 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→L3933Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment→L3935Finger orthosis, nontorsion joint, may include soft interface, custom fabricated, includes fitting and adjustment→L3956Addition of joint to upper extremity orthosis, any material; per joint→L3960Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment→L3961Shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment→L3962Shoulder elbow wrist hand orthosis, abduction positioning, erb's palsey design, prefabricated, includes fitting and adjustment→L3967Shoulder 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→L3971Shoulder 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→L3973Shoulder 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→L3975Shoulder elbow wrist hand finger orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment→L3976Shoulder 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→L3977Shoulder 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→L3978Shoulder 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→L3980Upper extremity fracture orthosis, humeral, prefabricated, includes fitting and adjustment→L3981Upper extremity fracture orthosis, humeral, prefabricated, includes shoulder cap design, with or without joints, forearm section, may include soft interface, straps, includes fitting and adjustments→L3982Upper extremity fracture orthosis, radius/ulnar, prefabricated, includes fitting and adjustment→L3984Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment→L3995Addition to upper extremity orthosis, sock, fracture or equal, each→L3999Upper limb orthosis, not otherwise specified→
Procedure codeCODABLE
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
- Part
- HCPCS Level II
- L
- Orthotic and Prosthetic Procedures and Devices
- L3
- L3000–L3999
Source
CMS — ICD-10-PCS FY2026, HCPCS Level II october 2026, Procedure Codes 2026.