HCPCS Level II · Section L

Section L: Orthotic and Prosthetic Procedures

936 procedure codes. CMS quarterly release — October 2026.

HCPCS Level II codes are updated quarterly by CMS. This listing reflects the October 2026 quarterly release.

Code	Description	Pricing
L0112	Cranial cervical orthosis	38
L0113	Cranial cervical torticollis	38
L0120	Cerv flex n/adj foam pre ots	38
L0130	Flex thermoplastic collar mo	38
L0140	Cervical semi-rigid adjustab	38
L0150	Cerv semi-rig adj molded chn	38
L0160	Cerv sr wire occ/man pre ots	38
L0170	Cervical collar molded to pt	38
L0172	Cerv col sr foam 2pc pre ots	38
L0174	Cerv sr 2pc thor ext pre ots	38
L0180	Cer post col occ/man sup adj	38
L0190	Cerv collar supp adj cerv ba	38
L0200	Cerv col supp adj bar & thor	38
L0220	Thor rib belt custom fabrica	38
L0450	Tlso flex trunk/thor pre ots	38
L0452	Tlso flex custom fab thoraci	38
L0454	Tlso trnk sj-t9 pre cst	38
L0455	Tlso flex trnk sj-t9 pre ots	38
L0456	Tlso flex trnk sj-ss pre cst	38
L0457	Tlso flex trnk sj-ss pre ots	38
L0458	Tlso 2mod symphis-xipho pre	38
L0460	Tlso 2 shl symphys-stern cst	38
L0462	Tlso 3mod sacro-scap pre	38
L0464	Tlso 4mod sacro-scap pre	38
L0466	Tlso r fram soft ant pre cst	38
L0467	Tlso r fram soft pre ots	38
L0468	Tlso rig fram pelvic pre cst	38
L0469	Tlso rig fram pelvic pre ots	38
L0470	Tlso rigid frame pre subclav	38
L0472	Tlso rigid frame hyperex pre	38
L0480	Tlso rigid plastic custom fa	38
L0482	Tlso rigid lined custom fab	38
L0484	Tlso rigid plastic cust fab	38
L0486	Tlso rigidlined cust fab two	38
L0488	Tlso rigid lined pre one pie	38
L0490	Tlso rigid plastic pre one	38
L0491	Tlso 2 piece rigid shell	38
L0492	Tlso 3 piece rigid shell	38
L0621	Sio flex pelvic/sacr pre ots	38
L0622	Sio flex pelvisacral custom	38
L0623	Sio rig pnl pelv/sac pre ots	38
L0624	Sio panel custom	38
L0625	Lo flex l1-below l5 pre ots	38
L0626	Lo sag rig pnl stays pre cst	38
L0627	Lo sag ri an/pos pnl pre cst	38
L0628	Lso flex no ri stays pre ots	38
L0629	Lso flex w/rigid stays cust	38
L0630	Lso r post pnl sj-t9 pre cst	38
L0631	Lso sag r an/pos pnl pre cst	38
L0632	Lso sag rigid frame cust	38
L0633	Lso sc r pos/lat pnl pre cst	38
L0634	Lso flexion control custom	38
L0635	Lso sagit rigid panel prefab	38
L0636	Lso sagittal rigid panel cus	38
L0637	Lso sc r ant/pos pnl pre cst	38
L0638	Lso sag-coronal panel custom	38
L0639	Lso s/c shell/panel prefab	38
L0640	Lso s/c shell/panel custom	38
L0641	Lo rig pos pnl l1-l5 pre ots	38
L0642	Lo sag ri an/pos pnl pre ots	38
L0643	Lso sag ctr rigi pos pre ots	38
L0648	Lso sag r an/pos pnl pre ots	38
L0649	Lso sc r pos/lat pnl pre ots	38
L0650	Lso sc r ant/pos pnl pre ots	38
L0651	Lso sag-co shell pnl pre ots	38
L0700	Ctlso a-p-l control molded	38
L0710	Ctlso a-p-l control w/ inter	38
L0720	Ctlso a-p-l control custom	38
L0810	Halo cervical into jckt vest	38
L0820	Halo cervical into body jack	38
L0830	Halo cerv into milwaukee typ	38
L0859	Mri compatible system	38
L0861	Halo repl liner/interface	38
L0970	Tlso corset front	38
L0972	Lso corset front	38
L0974	Tlso full corset	38
L0976	Lso full corset	38
L0978	Axillary crutch extension	38
L0980	Peroneal straps pair pre ots	38
L0982	Stocking sup grips 4 pre ots	38
L0984	Protect body sock ea pre ots	38
L0999	Add to spinal orthosis nos	46
L1000	Ctlso milwauke initial model	38
L1001	Ctlso infant immobilizer	38
L1005	Tension based scoliosis orth	38
L1006	Scoliosis orth sag/ cor	38
L1007	Scoliosis orth s-c custom	46
L1010	Ctlso axilla sling	38
L1020	Kyphosis pad	38
L1025	Kyphosis pad floating	38
L1030	Lumbar bolster pad	38
L1040	Lumbar or lumbar rib pad	38
L1050	Sternal pad	38
L1060	Thoracic pad	38
L1070	Trapezius sling	38
L1080	Outrigger	38
L1085	Outrigger bil w/ vert extens	38
L1090	Lumbar sling	38
L1100	Ring flange plastic/leather	38
L1110	Ring flange plas/leather mol	38
L1120	Covers for upright each	38
L1200	Furnsh initial orthosis only	38
L1210	Lateral thoracic extension	38
L1220	Anterior thoracic extension	38
L1230	Milwaukee type superstructur	38
L1240	Lumbar derotation pad	38
L1250	Anterior asis pad	38
L1260	Anterior thoracic derotation	38
L1270	Abdominal pad	38
L1280	Rib gusset (elastic) each	38
L1290	Lateral trochanteric pad	38
L1300	Body jacket mold to patient	38
L1310	Post-operative body jacket	38
L1320	Pectus carinatum ortho cust	46
L1330	Sternocostal orthosis prefab	46
L1499	Spinal orthosis nos	46
L1600	Ho flex frejka w/cov pre cst	38
L1610	Ho frejka cov only pre cst	38
L1620	Ho flex pavlik harns pre cst	38
L1630	Abduct control hip semi-flex	38
L1640	Pelv band/spread bar thigh c	38
L1650	Ho abduction hip adjustable	38
L1652	Ho bi thighcuffs w sprdr bar	38
L1653	Ho abduction static ots	38
L1660	Ho abduction static plastic	38
L1680	Pelvic & hip control thigh c	38
L1681	Ho bilateral hip abduction	38
L1685	Post-op hip abduct custom fa	38
L1686	Ho post-op hip abduction	38
L1690	Combination bilateral ho	38
L1700	Leg perthes orth toronto typ	38
L1710	Legg perthes orth newington	38
L1720	Legg perthes orthosis trilat	38
L1730	Legg perthes orth scottish r	38
L1755	Legg perthes patten bottom t	38
L1810	Ko elastic with joints	38
L1812	Ko elastic w/joints pre ots	38
L1820	Ko elas w/ condyle pads & jo	38
L1821	Ko elas w/ condyle pads otf	38
L1830	Ko immob canvas long pre ots	38
L1831	Knee orth pos locking joint	38
L1832	Ko adj jnt pos r sup pre cst	38
L1833	Ko adj jnt pos r sup pre ots	38
L1834	Ko w/0 joint rigid molded to	38
L1836	Ko rigid w/o joints pre ots	38
L1840	Ko derot ant cruciate custom	38
L1843	Ko single upright pre cst	38
L1844	Ko w/adj jt rot cntrl molded	38
L1845	Ko double upright pre cst	38
L1846	Ko w adj flex/ext rotat mold	38
L1847	Ko dbl upright w/air pre cst	38
L1848	Ko dbl upright w/air pre ots	38
L1850	Ko swedish type pre ots	38
L1851	Ko single upright prefab ots	38
L1852	Ko double upright prefab ots	38
L1860	Ko supracondylar socket mold	38
L1900	Afo sprng wir drsflx calf bd	38
L1902	Afo ankle gauntlet pre ots	38
L1904	Afo molded ankle gauntlet	38
L1906	Afo multilig ank sup pre ots	38
L1907	Afo supramalleolar custom	38
L1910	Afo sing bar clasp attach sh	38
L1920	Afo sing upright w/ adjust s	38
L1930	Afo plastic	38
L1932	Afo rig ant tib tcf/= custom	38
L1933	Afo rig ant tib tcf/= ots	38
L1940	Afo molded to patient plasti	38
L1945	Afo molded plas rig ant tib	38
L1950	Afo spiral molded to pt plas	38
L1951	Afo spiral prefab custom	38
L1952	Afo spiral prefab ots	38
L1960	Afo pos solid ank plastic mo	38
L1970	Afo plastic molded w/ankle j	38
L1971	Ankl foot ortho, customi fit	38
L1972	Ankl foot ortho, prefab, off	38
L1980	Afo sing solid stirrup calf	38
L1990	Afo doub solid stirrup calf	38
L2000	Kafo sing fre stirr thi/calf	38
L2005	Kafo sng/dbl mechanical act	38
L2006	Kaf sng/dbl swg/stn mcpr cus	38
L2010	Kafo sng solid stirrup w/o j	38
L2020	Kafo dbl solid stirrup band/	38
L2030	Kafo dbl solid stirrup w/o j	38
L2034	Kafo pla sin up w/wo k/a cus	38
L2035	Kafo plastic pediatric size	38
L2036	Kafo plas doub free knee mol	38
L2037	Kafo plas sing free knee mol	38
L2038	Kafo w/o joint multi-axis an	38
L2040	Hkafo torsion bil rot straps	38
L2050	Hkafo torsion cable hip pelv	38
L2060	Hkafo torsion ball bearing j	38
L2070	Hkafo torsion unilat rot str	38
L2080	Hkafo unilat torsion cable	38
L2090	Hkafo unilat torsion ball br	38
L2106	Afo tib fx cast plaster mold	38
L2108	Afo tib fx cast molded to pt	38
L2112	Afo tibial fracture soft	38
L2114	Afo tib fx semi-rigid	38
L2116	Afo tibial fracture rigid	38
L2126	Kafo fem fx cast thermoplas	38
L2128	Kafo fem fx cast molded to p	38
L2132	Kafo femoral fx cast soft	38
L2134	Kafo fem fx cast semi-rigid	38
L2136	Kafo femoral fx cast rigid	38
L2180	Plas shoe insert w ank joint	38
L2182	Drop lock knee	38
L2184	Limited motion knee joint	38
L2186	Adj motion knee jnt lerman t	38
L2188	Quadrilateral brim	38
L2190	Waist belt	38
L2192	Pelvic band & belt thigh fla	38
L2200	Limited ankle motion ea jnt	38
L2210	Dorsiflexion assist each joi	38
L2220	Dorsi & plantar flex ass/res	38
L2221	Ank mcrop plant & dorsi flex	38
L2230	Split flat caliper stirr & p	38
L2232	Rocker bottom, contact afo	38
L2240	Round caliper and plate atta	38
L2250	Foot plate molded stirrup at	38
L2260	Reinforced solid stirrup	38
L2265	Long tongue stirrup	38
L2270	Varus/valgus strap padded/li	38
L2275	Plastic mod low ext pad/line	38
L2280	Molded inner boot	38
L2300	Abduction bar jointed adjust	38
L2310	Abduction bar-straight	38
L2320	Non-molded lacer	38
L2330	Lacer molded to patient mode	38
L2335	Anterior swing band	38
L2340	Pre-tibial shell molded to p	38
L2350	Prosthetic type socket molde	38
L2360	Extended steel shank	38
L2370	Patten bottom	38
L2375	Torsion ank & half solid sti	38
L2380	Torsion straight knee joint	38
L2385	Straight knee joint heavy du	38
L2387	Add le poly knee custom kafo	38
L2390	Offset knee joint each	38
L2395	Offset knee joint heavy duty	38
L2397	Suspension sleeve lower ext	38
L2405	Knee joint drop lock ea jnt	38
L2415	Knee joint cam lock each joi	38
L2425	Knee disc/dial lock/adj flex	38
L2430	Knee jnt ratchet lock ea jnt	38
L2492	Knee lift loop drop lock rin	38
L2500	Thi/glut/ischia wgt bearing	38
L2510	Th/wght bear quad-lat brim m	38
L2520	Th/wght bear quad-lat brim c	38
L2525	Th/wght bear nar m-l brim mo	38
L2526	Th/wght bear nar m-l brim cu	38
L2530	Thigh/wght bear lacer non-mo	38
L2540	Thigh/wght bear lacer molded	38
L2550	Thigh/wght bear high roll cu	38
L2570	Hip clevis type 2 posit jnt	38
L2580	Pelvic control pelvic sling	38
L2600	Hip clevis/thrust bearing fr	38
L2610	Hip clevis/thrust bearing lo	38
L2620	Pelvic control hip heavy dut	38
L2622	Hip joint adjustable flexion	38
L2624	Hip adj flex ext abduct cont	38
L2627	Plastic mold recipro hip & c	38
L2628	Metal frame recipro hip & ca	38
L2630	Pelvic control band & belt u	38
L2640	Pelvic control band & belt b	38
L2650	Pelv & thor control gluteal	38
L2660	Thoracic control thoracic ba	38
L2670	Thorac cont paraspinal uprig	38
L2680	Thorac cont lat support upri	38
L2750	Plating chrome/nickel pr bar	38
L2755	Carbon graphite lamination	38
L2760	Extension per extension per	38
L2768	Ortho sidebar disconnect	38
L2780	Non-corrosive finish	38
L2785	Drop lock retainer each	38
L2795	Knee control full kneecap	38
L2800	Knee cap medial or lateral p	38
L2810	Knee control condylar pad	38
L2820	Soft interface below knee se	38
L2830	Soft interface above knee se	38
L2840	Tibial length sock fx or equ	38
L2850	Femoral lgth sock fx or equa	38
L2861	Torsion mechanism knee/ankle	00
L2999	Lower extremity orthosis nos	46
L3000	Ft insert ucb berkeley shell	00
L3001	Foot insert remov molded spe	00
L3002	Foot insert plastazote or eq	00
L3003	Foot insert silicone gel eac	00
L3010	Foot longitudinal arch suppo	00
L3020	Foot longitud/metatarsal sup	00
L3030	Foot arch support remov prem	00
L3031	Foot lamin/prepreg composite	00
L3040	Ft arch suprt premold longit	00
L3050	Foot arch supp premold metat	00
L3060	Foot arch supp longitud/meta	00
L3070	Arch suprt att to sho longit	00
L3080	Arch supp att to shoe metata	00
L3090	Arch supp att to shoe long/m	00
L3100	Hallus-valgus nt dyn pre ots	00
L3140	Abduction rotation bar shoe	00
L3150	Abduct rotation bar w/o shoe	00
L3160	Shoe styled positioning dev	00
L3161	Foot, adductus position, adj	46
L3170	Foot plas heel stabi pre ots	00
L3201	Oxford w supinat/pronat inf	00
L3202	Oxford w/ supinat/pronator c	00
L3203	Oxford w/ supinator/pronator	00
L3204	Hightop w/ supp/pronator inf	00
L3206	Hightop w/ supp/pronator chi	00
L3207	Hightop w/ supp/pronator jun	00
L3208	Surgical boot each infant	00
L3209	Surgical boot each child	00
L3211	Surgical boot each junior	00
L3212	Benesch boot pair infant	00
L3213	Benesch boot pair child	00
L3214	Benesch boot pair junior	00
L3215	Orthopedic ftwear ladies oxf	00
L3216	Orthoped ladies shoes dpth i	00
L3217	Ladies shoes hightop depth i	00
L3219	Orthopedic mens shoes oxford	00
L3221	Orthopedic mens shoes dpth i	00
L3222	Mens shoes hightop depth inl	00
L3224	Woman's shoe oxford brace	38
L3225	Man's shoe oxford brace	38
L3230	Custom shoes depth inlay	00
L3250	Custom mold shoe remov prost	00
L3251	Shoe molded to pt silicone s	00
L3252	Shoe molded plastazote cust	00
L3253	Shoe molded plastazote cust	00
L3254	Orth foot non-stndard size/w	00
L3255	Orth foot non-standard size/	00
L3257	Orth foot add charge split s	00
L3260	Ambulatory surgical boot eac	00
L3265	Plastazote sandal each	00
L3300	Sho lift taper to metatarsal	00
L3310	Shoe lift elev heel/sole neo	00
L3320	Shoe lift elev heel/sole cor	00
L3330	Lifts elevation metal extens	00
L3332	Shoe lifts tapered to one-ha	00
L3334	Shoe lifts elevation heel /i	00
L3340	Shoe wedge sach	00
L3350	Shoe heel wedge	00
L3360	Shoe sole wedge outside sole	00
L3370	Shoe sole wedge between sole	00
L3380	Shoe clubfoot wedge	00
L3390	Shoe outflare wedge	00
L3400	Shoe metatarsal bar wedge ro	00
L3410	Shoe metatarsal bar between	00
L3420	Full sole/heel wedge btween	00
L3430	Sho heel count plast reinfor	00
L3440	Heel leather reinforced	00
L3450	Shoe heel sach cushion type	00
L3455	Shoe heel new leather standa	00
L3460	Shoe heel new rubber standar	00
L3465	Shoe heel thomas with wedge	00
L3470	Shoe heel thomas extend to b	00
L3480	Shoe heel pad & depress for	00
L3485	Shoe heel pad removable for	00
L3500	Ortho shoe add leather insol	00
L3510	Orthopedic shoe add rub insl	00
L3520	O shoe add felt w leath insl	00
L3530	Ortho shoe add half sole	00
L3540	Ortho shoe add full sole	00
L3550	O shoe add standard toe tap	00
L3560	O shoe add horseshoe toe tap	00
L3570	O shoe add instep extension	00
L3580	O shoe add instep velcro clo	00
L3590	O shoe convert to sof counte	00
L3595	Ortho shoe add march bar	00
L3600	Trans shoe calip plate exist	00
L3610	Trans shoe caliper plate new	00
L3620	Trans shoe solid stirrup exi	00
L3630	Trans shoe solid stirrup new	00
L3640	Shoe dennis browne splint bo	00
L3649	Orthopedic shoe modifica nos	00
L3650	So 8 abd restraint pre ots	38
L3660	So 8 ab rstr can/web pre ots	38
L3670	So acro/clav can web pre ots	38
L3671	So cap design w/o jnts cf	38
L3674	So airplane w/wo joint cf	38
L3675	So vest canvas/web pre ots	38
L3677	So hard plas stabili pre cst	00
L3678	So hard plas stabili pre ots	38
L3702	Eo w/o joints cf	38
L3710	Eo elas w/metal jnts pre ots	38
L3720	Forearm/arm cuffs free motio	38
L3730	Forearm/arm cuffs ext/flex a	38
L3740	Cuffs adj lock w/ active con	38
L3760	Eo adj jt prefab custom fit	38
L3761	Eo, adj lock joint prefab ot	38
L3762	Eo rigid w/o joints pre ots	38
L3763	Ewho rigid w/o jnts cf	38
L3764	Ewho w/joint(s) cf	38
L3765	Ewhfo rigid w/o jnts cf	38
L3766	Ewhfo w/joint(s) cf	38
L3806	Whfo w/joint(s) custom fab	38
L3807	Whfo w/o joints pre cst	38
L3808	Whfo, rigid w/o joints	38
L3809	Whfo w/o joints pre ots	38
L3891	Torsion mechanism wrist/elbo	00
L3900	Hinge extension/flex wrist/f	38
L3901	Hinge ext/flex wrist finger	38
L3904	Whfo electric custom fitted	38
L3905	Who w/nontorsion jnt(s) cf	38
L3906	Who w/o joints cf	38
L3908	Who cock-up nonmolde pre ots	38
L3912	Hfo flexion glove pre ots	38
L3913	Hfo w/o joints cf	38
L3915	Who nontorsion jnts pre cst	38
L3916	Who nontorsion jnts pre ots	38
L3917	Metacarp fx orthosis pre cst	38
L3918	Metacarp fx orthosis pre ots	38
L3919	Ho w/o joints cf	38
L3921	Hfo w/joint(s) cf	38
L3923	Hfo without joints pre cst	38
L3924	Hfo without joints pre ots	38
L3925	Fo pip dip jnt/sprng pre ots	38
L3927	Fo pip dip no jt spr pre ots	38
L3929	Hfo nontorsion jnts pre cst	38
L3930	Hfo nontorsion jnts pre ots	38
L3931	Whfo nontorsion joint prefab	38
L3933	Fo w/o joints cf	38
L3935	Fo nontorsion joint cf	38
L3956	Add joint upper ext orthosis	38
L3960	Sewho airplan desig abdu pos	38
L3961	Sewho cap design w/o jnts cf	38
L3962	Sewho erbs palsey design abd	38
L3967	Sewho airplane w/o jnts cf	38
L3971	Sewho cap design w/jnt(s) cf	38
L3973	Sewho airplane w/jnt(s) cf	38
L3975	Sewhfo cap design w/o jnt cf	38
L3976	Sewhfo airplane w/o jnts cf	38
L3977	Sewhfo cap desgn w/jnt(s) cf	38
L3978	Sewhfo airplane w/jnt(s) cf	38
L3980	Up ext fx orthos humeral nos	38
L3981	Ue fx orth shoul cap forearm	38
L3982	Upper ext fx orthosis rad/ul	38
L3984	Upper ext fx orthosis wrist	38
L3995	Sock fracture or equal each	38
L3999	Upper limb orthosis nos	46
L4000	Repl girdle milwaukee orth	38
L4002	Replace strap, any orthosis	38
L4010	Replace trilateral socket br	38
L4020	Replace quadlat socket brim	38
L4030	Replace socket brim cust fit	38
L4040	Replace molded thigh lacer	38
L4045	Replace non-molded thigh lac	38
L4050	Replace molded calf lacer	38
L4055	Replace non-molded calf lace	38
L4060	Replace high roll cuff	38
L4070	Replace prox & dist upright	38
L4080	Repl met band kafo-afo prox	38
L4090	Repl met band kafo-afo calf/	38
L4100	Repl leath cuff kafo prox th	38
L4110	Repl leath cuff kafo-afo cal	38
L4130	Replace pretibial shell	38
L4205	Ortho dvc repair per 15 min	46
L4210	Orth dev repair/repl minor p	46
L4350	Ankle control ortho pre ots	38
L4360	Pneumat walking boot pre cst	38
L4361	Pneuma/vac walk boot pre ots	38
L4370	Pneum full leg splnt pre ots	38
L4386	Non-pneum walk boot pre cst	38
L4387	Non-pneum walk boot pre ots	38
L4392	Replace afo soft interface	38
L4394	Replace foot drop spint	38
L4396	Static or dynami afo pre cst	38
L4397	Static or dynami afo pre ots	38
L4398	Foot drop splint pre ots	38
L4631	Afo, walk boot type, cus fab	38
L5000	Sho insert w arch toe filler	38
L5010	Mold socket ank hgt w/ toe f	38
L5020	Tibial tubercle hgt w/ toe f	38
L5050	Ank symes mold sckt sach ft	38
L5060	Symes met fr leath socket ar	38
L5100	Molded socket shin sach foot	38
L5105	Plast socket jts/thgh lacer	38
L5150	Mold sckt ext knee shin sach	38
L5160	Mold socket bent knee shin s	38
L5200	Kne sing axis fric shin sach	38
L5210	No knee/ankle joints w/ ft b	38
L5220	No knee joint with artic ali	38
L5230	Fem focal defic constant fri	38
L5250	Hip canad sing axi cons fric	38
L5270	Tilt table locking hip sing	38
L5280	Hemipelvect canad sing axis	38
L5301	Bk mold socket sach ft endo	38
L5312	Knee disart, sach ft, endo	38
L5321	Ak open end sach	38
L5331	Hip disart canadian sach ft	38
L5341	Hemipelvectomy canadian sach	38
L5400	Postop dress & 1 cast chg bk	38
L5410	Postop dsg bk ea add cast ch	38
L5420	Postop dsg & 1 cast chg ak/d	38
L5430	Postop dsg ak ea add cast ch	38
L5450	Postop app non-wgt bear dsg	38
L5460	Postop app non-wgt bear dsg	38
L5500	Init bk ptb plaster direct	38
L5505	Init ak ischal plstr direct	38
L5510	Prep bk ptb plaster molded	38
L5520	Perp bk ptb thermopls direct	38
L5530	Prep bk ptb thermopls molded	38
L5535	Prep bk ptb open end socket	38
L5540	Prep bk ptb laminated socket	38
L5560	Prep ak ischial plast molded	38
L5570	Prep ak ischial direct form	38
L5580	Prep ak ischial thermo mold	38
L5585	Prep ak ischial open end	38
L5590	Prep ak ischial laminated	38
L5595	Hip disartic sach thermopls	38
L5600	Hip disart sach laminat mold	38
L5610	Above knee hydracadence	38
L5611	Ak 4 bar link w/fric swing	38
L5613	Ak 4 bar ling w/hydraul swig	38
L5614	4-bar link above knee w/swng	38
L5615	Ak 4 bar link hydl swg/stanc	38
L5616	Ak univ multiplex sys frict	38
L5617	Ak/bk self-aligning unit ea	38
L5618	Test socket symes	38
L5620	Test socket below knee	38
L5622	Test socket knee disarticula	38
L5624	Test socket above knee	38
L5626	Test socket hip disarticulat	38
L5628	Test socket hemipelvectomy	38
L5629	Below knee acrylic socket	38
L5630	Syme typ expandabl wall sckt	38
L5631	Ak/knee disartic acrylic soc	38
L5632	Symes type ptb brim design s	38
L5634	Symes type poster opening so	38
L5636	Symes type medial opening so	38
L5637	Below knee total contact	38
L5638	Below knee leather socket	38
L5639	Below knee wood socket	38
L5640	Knee disarticulat leather so	38
L5642	Above knee leather socket	38
L5643	Hip flex inner socket ext fr	38
L5644	Above knee wood socket	38
L5645	Bk flex inner socket ext fra	38
L5646	Below knee cushion socket	38
L5647	Below knee suction socket	38
L5648	Above knee cushion socket	38
L5649	Isch containmt/narrow m-l so	38
L5650	Tot contact ak/knee disart s	38
L5651	Ak flex inner socket ext fra	38
L5652	Suction susp ak/knee disart	38
L5653	Knee disart expand wall sock	38
L5654	Socket insert symes	38
L5655	Socket insert below knee	38
L5656	Socket insert knee articulat	38
L5657	Add low ext man aut vol any	38
L5658	Socket insert above knee	38
L5661	Multi-durometer symes	38
L5665	Multi-durometer below knee	38
L5666	Below knee cuff suspension	38
L5668	Bk molded distal cushion	38
L5670	Bk molded supracondylar susp	38
L5671	Bk/ak locking mechanism	38
L5672	Bk removable medial brim sus	38
L5673	Socket insert w lock mech	38
L5676	Bk knee joints single axis p	38
L5677	Bk knee joints polycentric p	38
L5678	Bk joint covers pair	38
L5679	Socket insert w/o lock mech	38
L5680	Bk thigh lacer non-molded	38
L5681	Intl custm cong/latyp insert	38
L5682	Bk thigh lacer glut/ischia m	38
L5683	Initial custom socket insert	38
L5684	Bk fork strap	38
L5685	Below knee sus/seal sleeve	38
L5686	Bk back check	38
L5688	Bk waist belt webbing	38
L5690	Bk waist belt padded and lin	38
L5692	Ak pelvic control belt light	38
L5694	Ak pelvic control belt pad/l	38
L5695	Ak sleeve susp neoprene/equa	38
L5696	Ak/knee disartic pelvic join	38
L5697	Ak/knee disartic pelvic band	38
L5698	Ak/knee disartic silesian ba	38
L5699	Shoulder harness	38
L5700	Replace socket below knee	38
L5701	Replace socket above knee	38
L5702	Replace socket hip	38
L5703	Symes ankle w/o (sach) foot	38
L5704	Custom shape cover bk	38
L5705	Custom shape cover ak	38
L5706	Custom shape cvr knee disart	38
L5707	Custom shape cvr hip disart	38
L5710	Kne-shin exo sng axi mnl loc	38
L5711	Knee-shin exo mnl lock ultra	38
L5712	Knee-shin exo frict swg & st	38
L5714	Knee-shin exo variable frict	38
L5716	Knee-shin exo mech stance ph	38
L5718	Knee-shin exo frct swg & sta	38
L5722	Knee-shin pneum swg frct exo	38
L5724	Knee-shin exo fluid swing ph	38
L5726	Knee-shin ext jnts fld swg e	38
L5728	Knee-shin fluid swg & stance	38
L5780	Knee-shin pneum/hydra pneum	38
L5781	Lower limb pros vacuum pump	38
L5782	Hd low limb pros vacuum pump	38
L5783	Add low ext mec limb vol lam	38
L5785	Exoskeletal bk ultralt mater	38
L5790	Exoskeletal ak ultra-light m	38
L5795	Exoskel hip ultra-light mate	38
L5810	Endoskel knee-shin mnl lock	38
L5811	Endo knee-shin mnl lck ultra	38
L5812	Endo knee-shin frct swg & st	38
L5814	Endo knee-shin hydral swg ph	38
L5816	Endo knee-shin polyc mch sta	38
L5818	Endo knee-shin frct swg & st	38
L5822	Endo knee-shin pneum swg frc	38
L5824	Endo knee-shin fluid swing p	38
L5826	Miniature knee joint	38
L5827	Endo knee shin single axis	38
L5828	Endo knee-shin fluid swg/sta	38
L5830	Endo knee-shin pneum/swg pha	38
L5840	Multi-axial knee/shin system	38
L5841	Addition endoskletl knee-shi	38
L5845	Knee-shin sys stance flexion	38
L5848	Knee-shin sys hydraul stance	38
L5850	Endo ak/hip knee extens assi	38
L5855	Mech hip extension assist	38
L5856	Elec knee-shin swing/stance	38
L5857	Elec knee-shin swing only	38
L5858	Stance phase only	38
L5859	Knee-shin pro flex/ext cont	38
L5910	Endo below knee alignable sy	38
L5920	Endo ak/hip alignable system	38
L5925	Above knee manual lock	38
L5926	Endoskel posit rotat unit	38
L5930	High activity knee frame	38
L5940	Endo bk ultra-light material	38
L5950	Endo ak ultra-light material	38
L5960	Endo hip ultra-light materia	38
L5961	Endo poly hip, pneu/hyd/rot	38
L5962	Below knee flex cover system	38
L5964	Above knee flex cover system	38
L5966	Hip flexible cover system	38
L5968	Multiaxial ankle w dorsiflex	38
L5969	Ak/ft power asst incl motors	38
L5970	Foot external keel sach foot	38
L5971	Sach foot, replacement	38
L5972	Flexible keel foot	38
L5973	Ank-foot sys dors-plant flex	38
L5974	Foot single axis ankle/foot	38
L5975	Combo ankle/foot prosthesis	38
L5976	Energy storing foot	38
L5978	Ft prosth multiaxial ankl/ft	38
L5979	Multi-axial ankle/ft prosth	38
L5980	Flex foot system	38
L5981	Flex-walk sys low ext prosth	38
L5982	Exoskeletal axial rotation u	38
L5984	Endoskeletal axial rotation	38
L5985	Lwr ext dynamic prosth pylon	38
L5986	Multi-axial rotation unit	38
L5987	Shank ft w vert load pylon	38
L5988	Vertical shock reducing pylo	38
L5990	User adjustable heel height	38
L5991	Low pros ext osseo connector	38
L5992	Low prosth foot shell repl	38
L5999	Lowr extremity prosthes nos	46
L6026	Part hand myo exclu term dev	38
L6028	Part hand finger metacar amp	38
L6029	Test interface part handfing	38
L6030	External frame part handfing	38
L6031	Rep interface handfng molded	38
L6032	Part handfng ultralite tcf/=	38
L6033	Part handfing acrylic	38
L6034	Part hand finger distal amp	38
L6035	Prosthetic digit mechanical	38
L6036	Prosthetic thumb mechanical	38
L6037	Postop dsg cast chg handfing	38
L6038	Multiax rotation attachment	38
L6039	Passive custom digit/thumb	38
L6050	Wrst mld sck flx hng tri pad	38
L6055	Wrst mold sock w/exp interfa	38
L6100	Elb mold sock flex hinge pad	38
L6110	Elbow mold sock suspension t	38
L6120	Elbow mold doub splt soc ste	38
L6130	Elbow stump activated lock h	38
L6200	Elbow mold outsid lock hinge	38
L6205	Elbow molded w/ expand inter	38
L6250	Elbow inter loc elbow forarm	38
L6300	Shlder disart int lock elbow	38
L6310	Shoulder passive restor comp	38
L6320	Shoulder passive restor cap	38
L6350	Thoracic intern lock elbow	38
L6360	Thoracic passive restor comp	38
L6370	Thoracic passive restor cap	38
L6380	Postop dsg cast chg wrst/elb	38
L6382	Postop dsg cast chg elb dis/	38
L6384	Postop dsg cast chg shlder/t	38
L6386	Postop ea cast chg & realign	38
L6388	Postop applicat rigid dsg on	38
L6400	Below elbow prosth tiss shap	38
L6450	Elb disart prosth tiss shap	38
L6500	Above elbow prosth tiss shap	38
L6550	Shldr disar prosth tiss shap	38
L6570	Scap thorac prosth tiss shap	38
L6580	Wrist/elbow bowden cable mol	38
L6582	Wrist/elbow bowden cbl dir f	38
L6584	Elbow fair lead cable molded	38
L6586	Elbow fair lead cable dir fo	38
L6588	Shdr fair lead cable molded	38
L6590	Shdr fair lead cable direct	38
L6600	Polycentric hinge pair	38
L6605	Single pivot hinge pair	38
L6610	Flexible metal hinge pair	38
L6611	Additional switch, ext power	38
L6615	Disconnect locking wrist uni	38
L6616	Disconnect insert locking wr	38
L6620	Flexion/extension wrist unit	38
L6621	Flex/ext wrist w/wo friction	38
L6623	Spring-ass rot wrst w/ latch	38
L6624	Flex/ext/rotation wrist unit	38
L6625	Rotation wrst w/ cable lock	38
L6628	Quick disconn hook adapter o	38
L6629	Lamination collar w/ couplin	38
L6630	Stainless steel any wrist	38
L6632	Latex suspension sleeve each	38
L6635	Lift assist for elbow	38
L6637	Nudge control elbow lock	38
L6638	Elec lock on manual pw elbow	38
L6640	Shoulder abduction joint pai	38
L6641	Excursion amplifier pulley t	38
L6642	Excursion amplifier lever ty	38
L6645	Shoulder flexion-abduction j	38
L6646	Multipo locking shoulder jnt	38
L6647	Shoulder lock actuator	38
L6648	Ext pwrd shlder lock/unlock	38
L6650	Shoulder universal joint	38
L6655	Standard control cable extra	38
L6660	Heavy duty control cable	38
L6665	Teflon or equal cable lining	38
L6670	Hook to hand cable adapter	38
L6672	Harness chest/shlder saddle	38
L6675	Harness figure of 8 sing con	38
L6676	Harness figure of 8 dual con	38
L6677	Ue triple control harness	38
L6680	Test sock wrist disart/bel e	38
L6682	Test sock elbw disart/above	38
L6684	Test socket shldr disart/tho	38
L6686	Suction socket	38
L6687	Frame typ socket bel elbow/w	38
L6688	Frame typ sock above elb/dis	38
L6689	Frame typ socket shoulder di	38
L6690	Frame typ sock interscap-tho	38
L6691	Removable insert each	38
L6692	Silicon gel insert w/wo lock	38
L6693	Lockingelbow forearm cntrbal	38
L6694	Elbow socket ins use w/lock	38
L6695	Elbow socket ins use w/o lck	38
L6696	Cus elbo skt in for con/atyp	38
L6697	Cus elbo skt in not con/atyp	38
L6698	Add up-ex prosthes lock mech	38
L6700	Ue add ext power myoel	38
L6703	Term dev, passive hand mitt	38
L6704	Term dev, sport/rec/work att	38
L6706	Term dev mech hook vol open	38
L6707	Term dev mech hook vol close	38
L6708	Term dev mech hand vol open	38
L6709	Term dev mech hand vol close	38
L6711	Ped term dev, hook, vol open	38
L6712	Ped term dev, hook, vol clos	38
L6713	Ped term dev, hand, vol open	38
L6714	Ped term dev, hand, vol clos	38
L6715	Term device, multi art digit	38
L6721	Hook/hand, hvy dty, vol open	38
L6722	Hook/hand, hvy dty, vol clos	38
L6805	Term dev modifier wrist unit	38
L6810	Term dev precision pinch dev	38
L6880	Elec hand ind art digits	38
L6881	Term dev auto grasp feature	38
L6882	Microprocessor control uplmb	38
L6883	Replc sockt below e/w disa	38
L6884	Replc sockt above elbow disa	38
L6885	Replc sockt shldr dis/interc	38
L6890	Prefab glove for term device	38
L6895	Custom glove for term device	38
L6900	Hand restorat thumb/1 finger	38
L6905	Hand restoration multiple fi	38
L6910	Hand restoration no fingers	38
L6915	Hand restoration replacmnt g	38
L6920	Wrist disarticul switch ctrl	38
L6925	Wrist disart myoelectronic c	38
L6930	Below elbow switch control	38
L6935	Below elbow myoelectronic ct	38
L6940	Elbow disarticulation switch	38
L6945	Elbow disart myoelectronic c	38
L6950	Above elbow switch control	38
L6955	Above elbow myoelectronic ct	38
L6960	Shldr disartic switch contro	38
L6965	Shldr disartic myoelectronic	38
L6970	Interscapular-thor switch ct	38
L6975	Interscap-thor myoelectronic	38
L7007	Adult electric hand	38
L7008	Pediatric electric hand	38
L7009	Adult electric hook	38
L7040	Prehensile actuator	38
L7045	Pediatric electric hook	38
L7170	Electronic elbow hosmer swit	38
L7180	Electronic elbow sequential	38
L7181	Electronic elbo simultaneous	38
L7185	Electron elbow adolescent sw	38
L7186	Electron elbow child switch	38
L7190	Elbow adolescent myoelectron	38
L7191	Elbow child myoelectronic ct	38
L7259	Electronic wrist rotator any	38
L7360	Six volt bat otto bock/eq ea	38
L7362	Battery chrgr six volt otto	38
L7364	Twelve volt battery utah/equ	38
L7366	Battery chrgr 12 volt utah/e	38
L7367	Replacemnt lithium ionbatter	38
L7368	Lithium ion battery charger	38
L7400	Add ue prost be/wd, ultlite	38
L7401	Add ue prost a/e ultlite mat	38
L7402	Add ue prost s/d ultlite mat	38
L7403	Add ue prost b/e acrylic	38
L7404	Add ue prost a/e acrylic	38
L7405	Add ue prost s/d acrylic	38
L7406	Add upp ext mec limb vol lam	38
L7499	Upper extremity prosthes nos	46
L7510	Prosthetic device repair rep	46
L7520	Repair prosthesis per 15 min	46
L7600	Prosthetic donning sleeve	00
L7700	Pros soc insert gasket/seal	38
L7900	Male vacuum erection system	00
L7902	Tension ring, vac erect dev	00
L8000	Mastectomy bra	38
L8001	Breast prosthesis bra & form	38
L8002	Brst prsth bra & bilat form	38
L8015	Ext breastprosthesis garment	38
L8020	Mastectomy form	38
L8030	Breast prosth w/o adhes any	38
L8031	Breast prosth w adhes any	38
L8032	Reusable nipple prosthesis	38
L8033	Nipple prosthesis custom, ea	38
L8035	Custom breast prosth any	38
L8039	Breast prosthesis nos	46
L8040	Nasal prosthesis	38
L8041	Midfacial prosthesis	38
L8042	Orbital prosthesis	38
L8043	Upper facial prosthesis	38
L8044	Hemi-facial prosthesis	38
L8045	Auricular prosthesis	38
L8046	Partial facial prosthesis	38
L8047	Nasal septal prosthesis	38
L8048	Unspec maxillofacial prosth	46
L8049	Repair maxillofacial prosth	46
L8300	Truss single w/ standard pad	38
L8310	Truss double w/ standard pad	38
L8320	Truss addition to std pad wa	38
L8330	Truss add to std pad scrotal	38
L8400	Sheath below knee	38
L8410	Sheath above knee	38
L8415	Sheath upper limb	38
L8417	Pros sheath/sock w gel cushn	38
L8420	Prosthetic sock multi ply bk	38
L8430	Prosthetic sock multi ply ak	38
L8435	Pros sock multi ply upper lm	38
L8440	Shrinker below knee	38
L8460	Shrinker above knee	38
L8465	Shrinker upper limb	38
L8470	Pros sock single ply bk	38
L8480	Pros sock single ply ak	38
L8485	Pros sock single ply upper l	38
L8499	Unlisted misc prosthetic ser	46
L8500	Artificial larynx	38
L8501	Tracheostomy speaking valve	38
L8505	Artificial larynx, accessory	46
L8507	Trach-esoph voice pros pt in	38
L8509	Trach-esoph voice pros md in	38
L8510	Voice amplifier	38
L8511	Indwelling trach insert	38
L8512	Gel cap for trach voice pros	38
L8513	Trach pros cleaning device	38
L8514	Repl trach puncture dilator	38
L8515	Gel cap app device for trach	37
L8600	Implant breast silicone/eq	38
L8603	Collagen imp urinary 2.5 ml	38
L8604	Dextranomer/hyaluronic acid	00
L8605	Inj bulking agent anal canal	38
L8606	Synthetic implnt urinary 1ml	38
L8607	Inj vocal cord bulking agent	38
L8608	Arg ii ext com/sup/acc misc	46
L8609	Artificial cornea	38
L8610	Ocular implant	38
L8612	Aqueous shunt prosthesis	38
L8613	Ossicular implant	38
L8614	Cochlear device	38
L8615	Coch implant headset replace	38
L8616	Coch implant microphone repl	38
L8617	Coch implant trans coil repl	38
L8618	Coch implant tran cable repl	38
L8619	Coch imp ext proc/contr rplc	38
L8621	Repl zinc air battery	38
L8622	Repl alkaline battery	38
L8623	Lith ion batt cid,non-earlvl	38
L8624	Lith ion batt cid, ear level	38
L8625	Charger coch impl/aoi battry	38
L8627	Cid ext speech process repl	38
L8628	Cid ext controller repl	38
L8629	Cid transmit coil and cable	38
L8630	Metacarpophalangeal implant	38
L8631	Mcp joint repl 2 pc or more	38
L8641	Metatarsal joint implant	38
L8642	Hallux implant	38
L8658	Interphalangeal joint spacer	38
L8659	Interphalangeal joint repl	38
L8670	Vascular graft, synthetic	38
L8678	Ext sply implt neurostim	38
L8679	Imp neurosti pls gn any type	38
L8680	Implt neurostim elctr each	00
L8681	Pt prgrm for implt neurostim	38
L8682	Implt neurostim radiofq rec	38
L8683	Radiofq trsmtr for implt neu	38
L8684	Radiof trsmtr implt scrl neu	38
L8685	Implt nrostm pls gen sng rec	00
L8686	Implt nrostm pls gen sng non	00
L8687	Implt nrostm pls gen dua rec	00
L8688	Implt nrostm pls gen dua non	00
L8689	External recharg sys intern	38
L8690	Aud osseo dev, int/ext comp	38
L8691	Aoi snd proc repl excl actua	38
L8692	Non-osseointegrated snd proc	00
L8693	Aud osseo dev, abutment	38
L8694	Aoi transducer/actuator repl	38
L8695	External recharg sys extern	38
L8696	Ext antenna phren nerve stim	38
L8697	Ext phrenic stim acc repl ea	46
L8698	Misc used with tot art heart	46
L8699	Prosthetic implant nos	46
L8701	Ewh s/d uprt micro sensor	38
L8702	Ewhf s/d uprt micro sensor	38
L8720	Ext low ext sens prosthe mec	46
L8721	Receptor sole l8720 replace	46
L9900	O&p supply/accessory/service	46

Last reviewed: September 2026