HCPCS Range Orthotic Procedures and services

• 1 Cervical Orthotics (L0112-L0174)

• 2 Cervical Orthotics Multi-post Collar (L0180-L0200)

• 3 Thoracic Rib Belts (L0220-L0220)

• 4 Thoracic-lumbar-sacral (TLSO) Orthotics (L0450-L0492)

• 5 Sacral Orthotics (L0621-L0624)

• 6 Lumbar Orthotics (L0625-L0627)

• 7 Lumbar-sacral Orthotics (L0628-L0640)

• 8 Lumbar Orthotics Sagittal Control (L0641-L0642)

• 9 Lumbar-sacral Orthotics Sagittal Control (L0643-L0651)

• 10 Cervical-thoracic-lumbar-sacral Orthotics (L0700-L0710)

• 11 Cervical Halo Procedures (L0810-L0861)

• 12 Accessories for Spinal Orthotics (L0970-L0999)

• 13 Scoliosis Orthotic Devices (L1000-L1120)

• 14 Other Scoliosis and Spinal Orthotics and Procedures (L1300-L1499)

• 15 Hip Orthotics (L1600-L1690)

• 16 Legg Perthes Orthotics (L1700-L1755)

• 17 Knee Orthotics (L1810-L1860)

• 18 Ankle-foot Orthotics (L1900-L1990)

• 19 Knee-ankle-foot Orthotics (L2000-L2038)

• 20 Hip-knee-ankle-foot Orthotics (L2040-L2090)

• 21 Ankle-foot Orthotics (L2106-L2116)

• 22 Knee-ankle-foot Orthotics (L2126-L2136)

• 23 Additions, Lower Extremity, Fracture Orthotics (L2180-L2192)

• 24 Additions, Lower Extremity Orthotics (L2200-L2397)

• 25 Orthotic Additions to Knee Joints (L2405-L2492)

• 26 Additions, Weight-bearing, Lower Extremities (L2500-L2550)

• 27 Additions, Pelvic and/or Thoracic Control, Lower Extremities (L2570-L2680)

• 28 Other Lower Extremity Additions (L2750-L2999)

• 29 Foot Inserts, Removable (L3000-L3031)

• 30 Foot Arch Supports (L3040-L3090)

• 31 Repositioning Foot Orthotics (L3100-L3170)

• 32 Orthopedic Shoes (L3201-L3207)

• 33 Surgical Boots (L3208-L3211)

• 34 Benesch Boots (L3212-L3214)

• 35 Other Orthopedic Footwear (L3215-L3265)

• 36 Shoe Lifts (L3300-L3334)

• 37 Shoe Wedges (L3340-L3420)

• 38 Shoe Heels (L3430-L3485)

• 39 Other Orthopedic Shoe Additions (L3500-L3595)

• 40 Orthosis Transfers (L3600-L3649)

• 41 Shoulder Orthotics (L3650-L3678)

• 42 Elbow Orthotics (L3702-L3762)

• 43 Elbow-wrist-hand Orthotics (L3763-L3766)

• 44 Wrist-hand-finger Orthotics (L3806-L3904)

• 45 Wrist-hand Orthotics (L3905-L3908)

• 46 Additional Miscellaneous Orthotics, Upper Extremities (L3912-L3956)

• 47 Shoulder-elbow-wrist-hand Orthotics (L3960-L3973)

• 48 Shoulder-elbow-wrist-hand-finger Orthotics (L3975-L3978)

• 49 Fracture, Addition, and Unspecified Orthotics, Upper Extremities (L3980-L3999)

• 50 Orthotic Replacement Parts or Repair (L4000-L4210)

• 51 Other Lower Extremity Orthotics (L4350-L4631)

• 52 Low-profile Additions, Thoracic-lumbar-sacral Orthotics (L1200-L1290)