L Codes
What are L Codes?
An L Code is a level II healthcare common procedural coding system (HCPCS) code. An HCPCS code is a five-character alphanumeric code. The first character is a letter that describes the type of service billed and the other four numeric characters describe the specific type of service. L Codes are codes that bill for orthotics and prosthetics provided to patients. The “L” identifies the code is for an orthotic or prosthetic, and the numbers define what body part and type of orthosis/prosthesis, e.g. L 3906 is a custom fabricated static wrist hand orthosis.
View a complete listing of the 22 L Codes introduced by CMS in 2006 & 2007.
Medicare reimbursement L Codes by state
History of L Codes
In 2006, CMS collaborated with the ASHT L Code task force to create a new set of L codes that accurately described the orthotics that hand therapists make as part of their therapeutic interventions. In 2006/2007, twenty four new codes were implemented that are listed below. In addition to these 24 codes, there are two L Codes (3906 and 3730) that were in existence prior to the ASHT/CMS collaboration. Both codes apply to custom molded orthotics and were already in use by therapists as well as orthotists. Since the codes accurately described orthotics that therapists already fabricate, they were left as is. Also, recently CMS revised some L Codes as of January 1, 2011. These are further explained below.
The pictorial examples given for each code are provided only for instructional purposes and are not to be construed as the only type of orthosis that can be fabricated using that orthotic code. As long as your custom orthosis can be described by the specific code, as outlined below, then that is the code you will utilize to bill for your orthosis.
Medicare covered orthoses must be reasonable and necessary for the diagnosis or treatment of an illness or injury or to improve the functioning of a malformed body member. Congress passed a provision of the Social Security Act that states no payment shall be made for certain custom fabricated orthoses unless such items are furnished by a “qualified practitioner” who further includes a “qualified occupational therapist” and “qualified physical therapist” as well as other professions. Orthoses require a prescription and/or certificate of medical necessity signed by a physician. Orthoses can be provided to the patient in their home, and in other settings such as outpatient centers and SNF’s. CMS defines orthoses (found in the HCPCS Level II manual) and sets the fee schedule for the L Codes.
