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L3809
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Procedure Codes
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HCPCS Level II
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Orthotic and Prosthetic Procedures and Devices
/
L3000–L3999
L3809
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type
Back
L3000
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each
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L3001
Foot, insert, removable, molded to patient model, spenco, each
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L3002
Foot, insert, removable, molded to patient model, plastazote or equal, each
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L3003
Foot, insert, removable, molded to patient model, silicone gel, each
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L3010
Foot, insert, removable, molded to patient model, longitudinal arch support, each
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L3020
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each
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L3030
Foot, insert, removable, formed to patient foot, each
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L3031
Foot, insert/plate, removable, addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, each
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L3040
Foot, arch support, removable, premolded, longitudinal, each
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L3050
Foot, arch support, removable, premolded, metatarsal, each
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L3060
Foot, arch support, removable, premolded, longitudinal/ metatarsal, each
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L3070
Foot, arch support, non-removable attached to shoe, longitudinal, each
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L3080
Foot, arch support, non-removable attached to shoe, metatarsal, each
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L3090
Foot, arch support, non-removable attached to shoe, longitudinal/metatarsal, each
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L3100
Hallus-valgus night dynamic splint, prefabricated, off-the-shelf
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L3140
Foot, abduction rotation bar, including shoes
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L3150
Foot, abduction rotation bar, without shoes
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L3160
Foot, adjustable shoe-styled positioning device
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L3161
Foot, adductus positioning device, adjustable
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L3170
Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each
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L3201
Orthopedic shoe, oxford with supinator or pronator, infant
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L3202
Orthopedic shoe, oxford with supinator or pronator, child
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L3203
Orthopedic shoe, oxford with supinator or pronator, junior
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L3204
Orthopedic shoe, hightop with supinator or pronator, infant
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L3206
Orthopedic shoe, hightop with supinator or pronator, child
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L3207
Orthopedic shoe, hightop with supinator or pronator, junior
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L3208
Surgical boot, each, infant
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L3209
Surgical boot, each, child
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L3211
Surgical boot, each, junior
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L3212
Benesch boot, pair, infant
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L3213
Benesch boot, pair, child
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L3214
Benesch boot, pair, junior
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L3215
Orthopedic footwear, ladies shoe, oxford, each
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L3216
Orthopedic footwear, ladies shoe, depth inlay, each
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L3217
Orthopedic footwear, ladies shoe, hightop, depth inlay, each
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L3219
Orthopedic footwear, mens shoe, oxford, each
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L3221
Orthopedic footwear, mens shoe, depth inlay, each
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L3222
Orthopedic footwear, mens shoe, hightop, depth inlay, each
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L3224
Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthosis)
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L3225
Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis)
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L3230
Orthopedic footwear, custom shoe, depth inlay, each
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L3250
Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each
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L3251
Foot, shoe molded to patient model, silicone shoe, each
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L3252
Foot, shoe molded to patient model, plastazote (or similar), custom fabricated, each
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L3253
Foot, molded shoe plastazote (or similar) custom fitted, each
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L3254
Non-standard size or width
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L3255
Non-standard size or length
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L3257
Orthopedic footwear, additional charge for split size
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L3260
Surgical boot/shoe, each
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L3265
Plastazote sandal, each
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L3300
Lift, elevation, heel, tapered to metatarsals, per inch
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L3310
Lift, elevation, heel and sole, neoprene, per inch
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L3320
Lift, elevation, heel and sole, cork, per inch
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L3330
Lift, elevation, metal extension (skate)
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L3332
Lift, elevation, inside shoe, tapered, up to one-half inch
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L3334
Lift, elevation, heel, per inch
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L3340
Heel wedge, sach
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L3350
Heel wedge
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L3360
Sole wedge, outside sole
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L3370
Sole wedge, between sole
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L3380
Clubfoot wedge
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L3390
Outflare wedge
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L3400
Metatarsal bar wedge, rocker
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L3410
Metatarsal bar wedge, between sole
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L3420
Full sole and heel wedge, between sole
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L3430
Heel, counter, plastic reinforced
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L3440
Heel, counter, leather reinforced
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L3450
Heel, sach cushion type
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L3455
Heel, new leather, standard
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L3460
Heel, new rubber, standard
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L3465
Heel, thomas with wedge
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L3470
Heel, thomas extended to ball
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L3480
Heel, pad and depression for spur
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L3485
Heel, pad, removable for spur
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L3500
Orthopedic shoe addition, insole, leather
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L3510
Orthopedic shoe addition, insole, rubber
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L3520
Orthopedic shoe addition, insole, felt covered with leather
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L3530
Orthopedic shoe addition, sole, half
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L3540
Orthopedic shoe addition, sole, full
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L3550
Orthopedic shoe addition, toe tap standard
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L3560
Orthopedic shoe addition, toe tap, horseshoe
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L3570
Orthopedic shoe addition, special extension to instep (leather with eyelets)
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L3580
Orthopedic shoe addition, convert instep to velcro closure
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L3590
Orthopedic shoe addition, convert firm shoe counter to soft counter
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L3595
Orthopedic shoe addition, march bar
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L3600
Transfer of an orthosis from one shoe to another, caliper plate, existing
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L3610
Transfer of an orthosis from one shoe to another, caliper plate, new
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L3620
Transfer of an orthosis from one shoe to another, solid stirrup, existing
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L3630
Transfer of an orthosis from one shoe to another, solid stirrup, new
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L3640
Transfer of an orthosis from one shoe to another, dennis browne splint (riveton), both shoes
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L3649
Orthopedic shoe, modification, addition or transfer, not otherwise specified
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L3650
Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf
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L3660
Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf
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L3670
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf
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L3671
Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
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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
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L3675
Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf
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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
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L3678
Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated, off-the-shelf
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L3702
Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
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L3710
Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf
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L3720
Elbow orthosis, double upright with forearm/arm cuffs, free motion, custom fabricated
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L3730
Elbow orthosis, double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated
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L3740
Elbow orthosis, double upright with forearm/arm cuffs, adjustable position lock with active control, custom fabricated
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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
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L3761
Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, off-the-shelf
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L3762
Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf
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L3763
Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
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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
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L3765
Elbow wrist hand finger orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
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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
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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
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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
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L3808
Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment
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L3809
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type
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L3891
Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each
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L3900
Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, wrist or finger driven, custom fabricated
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L3901
Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom fabricated
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L3904
Wrist hand finger orthosis, external powered, electric, custom fabricated
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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
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L3906
Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
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L3908
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf
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L3912
Hand finger orthosis (hfo), flexion glove with elastic finger control, prefabricated, off-the-shelf
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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
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L3916
Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf
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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
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L3918
Hand orthosis, metacarpal fracture orthosis, prefabricated, off-the-shelf
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L3919
Hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
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L3921
Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
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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
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L3924
Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, off-the-shelf
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L3925
Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf
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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
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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
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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
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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
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L3933
Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment
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L3935
Finger orthosis, nontorsion joint, may include soft interface, custom fabricated, includes fitting and adjustment
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L3956
Addition of joint to upper extremity orthosis, any material; per joint
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L3960
Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment
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L3961
Shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
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L3962
Shoulder elbow wrist hand orthosis, abduction positioning, erb's palsey design, prefabricated, includes fitting and adjustment
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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
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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
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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
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L3975
Shoulder elbow wrist hand finger orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
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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
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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
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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
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L3980
Upper extremity fracture orthosis, humeral, prefabricated, includes fitting and adjustment
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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
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L3984
Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment
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L3995
Addition to upper extremity orthosis, sock, fracture or equal, each
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L3999
Upper limb orthosis, not otherwise specified
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Procedure code
CODABLE
L3809
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type
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.
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