HCPCS Range Other Lower Extremity Orthotics

• 1 Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf ( L4350 )

• 2 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 ( L4360 )

• 3 Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf ( L4361 )

• 4 Pneumatic full leg splint, prefabricated, off-the-shelf ( L4370 )

• 5 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 ( L4386 )

• 6 Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf ( L4387 )

• 7 Replacement, soft interface material, static AFO ( L4392 )

• 8 Replace soft interface material, foot drop splint ( L4394 )

• 9 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 ( L4396 )

• 10 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 ( L4397 )

• 11 Foot drop splint, recumbent positioning device, prefabricated, off-the-shelf ( L4398 )

• 12 Ankle foot orthosis (AFO), 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 ( L4631 )