License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA website.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

AMA Disclaimer of Warranties and Liabilities.

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CGS or the CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

CMS Disclaimer

The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

This license will terminate upon notice to you if you violate the terms of this license. The AMA is a third party beneficiary to this license.

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED "I ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "I DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN.

IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT-4 for resale and/or license, transferring copies of CDT-4 to any party not bound by this agreement, creating any modified or derivative work of CDT-4, or making any commercial use of CDT-4. License to use CDT-4 for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the American Dental Association website.
Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. Please click here to see all U.S. Government Rights Provisions.
ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CDT-4 is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT-4. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT-4 and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The ADA is a third-party beneficiary to this Agreement.
CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT-4 should be addressed to the ADA. End users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT-4. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I ACCEPT". If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must click below on the button labeled "I DO NOT ACCEPT" and exit from this computer screen.

Forms/Checklists/Guides

Local Coverage Determinations

Medical Review

Medicare Secondary Payer (MSP)

Print | Bookmark | Email | Font Size: + | –

Home » JB DME » News & Publications » News » 2021 » November » Correct Coding of Elbow, Shoulder, Shoulder-Elbow-Wrist-Hand and Shoulder-Elbow-Wrist-Hand-Finger Braces (Orthoses) – Revised

August 22, 2024

Correct Coding of Elbow, Shoulder, Shoulder-Elbow-Wrist-Hand and Shoulder-Elbow-Wrist-Hand-Finger Braces (Orthoses) – Revised

Joint DME MAC and PDAC Publication

Based on recent analysis of claims submitted to the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) for upper extremity braces, the DME MACs and the Pricing, Data Analysis and Coding (PDAC) Contractor want to remind Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) suppliers about the correct coding for these products.

The Medicare Program Integrity Manual (CMS Pub. 100-08), Chapter 3, Sections 3.3.B and 3.6.2.4 specify that for Medicare claims, only CMS and the DME MACs have the authority to establish Healthcare Common Procedure Coding System (HCPCS) Level II Coding Guidelines.

Correct HCPCS coding is a determination that the item provided to a beneficiary is billed using the appropriate HCPCS code for that item. Suppliers are required to correctly code for the item billed. An item/service is correctly coded when it meets all the coding guidelines listed in CMS HCPCS guidelines, Local Coverage Determinations (LCDs), LCD-related Policy Articles, or DME MAC articles.

Elbow Orthoses

L3702 (ELBOW ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT) describes a custom fabricated static positional orthosis that extends from the forearm to the middle humerus. This is a complete device and no add-on codes may be billed for this orthosis.

L3710 (ELBOW ORTHOSIS, ELASTIC WITH METAL JOINTS, PREFABRICATED, OFF-THE-SHELF) describes a prefabricated off-the-shelf (OTS) orthosis that extends from the forearm to mid-humerus with any type joints on both sides of the elbow. This is a complete device and no add-on codes may be billed for this orthosis.

L3720 (ELBOW ORTHOSIS, DOUBLE UPRIGHT WITH FOREARM/ARM CUFFS, FREE MOTION, CUSTOM FABRICATED) describes a dynamic custom fabricated orthosis with rigid or semi-rigid cuffs that extends from forearm to mid-humerus with free motion joints on both sides of the elbow. This is a complete device and no add-on codes may be billed for this orthosis.

L3730 (ELBOW ORTHOSIS, DOUBLE UPRIGHT WITH FOREARM/ARM CUFFS, EXTENSION/ FLEXION ASSIST, CUSTOM FABRICATED) describes a dynamic custom fabricated orthosis with rigid or semi-rigid cuffs and double uprights that extends from the forearm to mid-humerus. The orthosis has any type extension/flexion control joints that must have a minimum of 15 degrees of adjustability. This is a complete device and no add-on codes may be billed for this orthosis.

L3740 (ELBOW ORTHOSIS, DOUBLE UPRIGHT WITH FOREARM/ARM CUFFS, ADJUSTABLE POSITION LOCK WITH ACTIVE CONTROL, CUSTOM FABRICATED) describes a dynamic custom fabricated orthosis with rigid or semi-rigid cuffs and double uprights and cuffs that extends from the forearm to the wrist with any type adjustable joints that must have a minimum of 15 degrees of adjustability. The brace includes a shoulder harness assembly with a cable to activate the elbow lock. This is a complete device and no add-on codes may be billed for this orthosis.

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) describes a prefabricated custom fitted orthosis with rigid or semi-rigid cuffs and single or double uprights, that extends from the forearm to mid-humerus. The orthosis has any type extension/flexion control joint(s) that must have a minimum of 15 degrees of adjustability. It includes a soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.

L3761 (ELBOW ORTHOSIS (EO), WITH ADJUSTABLE POSITION LOCKING JOINT(S), PREFABRICATED, OFF-THE-SHELF) describes a prefabricated OTS orthosis with rigid or semi-rigid cuffs and single or double uprights, that extends from the forearm to mid-humerus. The orthosis has any type extension/flexion control joint(s) that must have a minimum of 15 degrees of adjustability. It includes a soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.

L3762 (ELBOW ORTHOSIS (EO), RIGID, WITHOUT JOINTS, INCLUDES SOFT INTERFACE MATERIAL, PREFABRICATED, OFF-THE-SHELF) describes a static rigid prefabricated OTS orthosis that extends from the forearm to mid-humerus. It includes a soft interface and any type straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.

L3763 (ELBOW WRIST HAND ORTHOSIS, RIGID, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT) describes a rigid static custom fabricated orthosis that extends from the humerus to the metacarpals. It includes a soft interface and any type straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.

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) describes a dynamic custom fabricated orthosis that extends from the humerus to the metacarpals. It includes any type supportive non-torsion joints connected to bars, elastic bands, turnbuckles used to support the elbow, wrist and hand. It includes a soft interface and any type straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.

L3765 (ELBOW WRIST HAND FINGER ORTHOSIS, RIGID, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT) describes a static custom fabricated orthosis that extends from the humerus to the phalanges. It includes a soft interface and any type straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.

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) describes a dynamic custom fabricated orthosis that extends from the humerus to the phalanges. The device may include supportive non-torsion joints connected to bars, elastic bands with outriggers. It includes a soft interface and any type straps and closures. This is a complete device and no add-on codes may be billed for this orthosis

Shoulder Orthoses

L3650 (SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, PREFABRICATED, OFF-THE-SHELF) describes a prefabricated OTS shoulder brace designed to support the clavicle from limiting motion of the shoulder joint complex. This is a complete device and no add-on codes may be billed for this orthosis.

L3660 (SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND WEBBING, PREFABRICATED, OFF-THE-SHELF) describes a prefabricated OTS shoulder brace designed to support the clavicle from limiting motion of the shoulder joint complex. It uses a canvas or webbing waist band and humeral band. This is a complete device and no add-on codes may be billed for this orthosis.

L3670 (SHOULDER ORTHOSIS, ACROMIO/CLAVICULAR (CANVAS AND WEBBING TYPE), PREFABRICATED, OFF-THE-SHELF) describes a prefabricated OTS product designed to support and immobilize the shoulder in multiple planes using a swathe and sling design. The product is made primarily made of canvas and webbing type materials. This is a complete device and no add-on codes may be billed for this orthosis.

L3671 (SHOULDER ORTHOSIS, SHOULDER JOINT DESIGN, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT) describes a static custom fabricated shoulder orthosis that extends from the top of the shoulder to above the elbow. The device is completely circumferential of the humeral bone and is used for support of the should joint. It includes a soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.

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) describes a static custom fabricated shoulder "airplane design" abduction orthosis. The product may include adjustable rigid cuffs and joints/components to optimize the shoulder angle in multiple planes. Shoulder position is capable of 90 degrees abduction from the torso in a fixed position. Adjustable rigid chest and pelvic frames or panels supports shoulder and arm components. It is used for abducting the arm away from the body and is capable of immobilizing the shoulder. It includes a soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.

L3675 (SHOULDER ORTHOSIS, VEST TYPE ABDUCTION RESTRAINER, CANVAS WEBBING TYPE OR EQUAL PREFABRICATED, OFF-THE-SHELF) describes an OTS prefabricated shoulder orthosis which abducts and immobilizes the shoulder joint in a canvas vest type device. Included in the code are closures from lacing, webbing, hook and loop, or equal, and additional support strapping. This is a complete device and no add-on codes may be billed for this orthosis.

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) describes a prefabricated custom fitted shoulder orthosis with rigid chest, arm, limited motion shoulder components which combine to restrict the shoulder from subluxation. Restricted motion of the shoulder is typically with abduction, retraction, and rotation. The device can be unilateral or bilateral. The device includes a soft interface and any type straps and closures and there are no additional add-on codes for this orthosis. The predicate product is the Shoulder Subluxation Inhibitor (Boston Brace International, Inc.). This is a complete device and no add-on codes may be billed for this orthosis.

L3678 (SHOULDER ORTHOSIS, SHOULDER JOINT DESIGN, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, PREFABRICATED, OFF-THE-SHELF) describes a prefabricated OTS shoulder orthosis with rigid chest, arm, limited motion shoulder components which combine to restrict the shoulder from subluxation. Restricted motion of the shoulder is typically with abduction, retraction, and rotation. The device can be unilateral or bilateral. The device includes a soft interface and any type straps and closures and there are no additional add-on codes for this orthosis. The predicate product is the Shoulder Subluxation Inhibitor (Boston Brace International, Inc.). This is a complete device and no add-on codes may be billed for this orthosis.

Shoulder-Elbow-Wrist-Hand Orthoses

L3960 (SHOULDER-ELBOW-WRIST-HAND ORTHOSIS, (SEWHO), ABDUCTION POSITIONING, AIRPLANE DESIGN, PREFABRICATED, INCLUDED FITTING AND ADJUSTMENT) describes a prefabricated custom fitted shoulder "airplane design" abduction orthosis which includes the elbow, wrist, hand and fingers. There are adjustable rigid cuffs and joints/components to optimize the shoulder, elbow, wrist, and hand angles. Shoulder position is capable of 90 degrees abduction from the torso. Adjustable rigid chest and pelvic frames or panels supports shoulder and arm components. The product is all-inclusive of a soft interface and closures/straps. It is used for abducting the arm away from the body and is capable of immobilizing the shoulder, elbow, wrist, and hand. This is a complete device and no add-on codes may be billed for this orthosis.

L3961 (SHOULDER ELBOW WRIST HAND ORTHOSIS, SHOULDER CAP DESIGN, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT) describes a static custom fabricated orthosis that extends from the top of the shoulder to the metacarpals. The product is all-inclusive of a soft interface and closures/straps. This is a complete device and no add-on codes may be billed for this orthosis.

L3962 (SHOULDER ELBOW WRIST HAND ORTHOSIS, ABDUCTION POSITIONING, ERB'S PALSY DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT) describes a dynamic prefabricated custom fitted shoulder orthosis which includes the elbow, wrist, hand and fingers. There are rigid cuffs with an extension to optimize the shoulder, elbow, wrist and hand angles. Shoulder position is capable of 90 degrees abduction from the torso. Adjustable rigid chest and pelvic frames or panels supports shoulder and arm components. It is used for positioning the shoulder in abduction, external rotation, elbow extension, with forearm supination and extension of wrist and fingers. The product is all-inclusive of a soft interface and closures/straps. This is a complete device and no add-on codes may be billed for this orthosis.

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) describes a static custom fabricated shoulder "airplane design" abduction orthosis which includes the elbow, wrist, hand and fingers. There are rigid cuffs with an extension to optimize the shoulder, elbow, wrist and hand angles. Shoulder position is capable of 90 degrees abduction from the torso. Adjustable rigid chest and pelvic frames or panels supports shoulder and arm components. It is used for abducting the arm away from the body and is capable of immobilizing the shoulder, elbow, wrist, and hand. The product is all-inclusive of a soft interface and closures/straps. This is a complete device and no add-on codes may be billed for this orthosis.

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) describes a dynamic custom fabricated shoulder orthosis that extends from the top of the shoulder to the phalanges. It includes supportive non-torsion joints, elastic bands, turnbuckles. It includes a soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.

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) describes dynamic static custom fabricated shoulder "airplane design" abduction orthosis which includes the elbow, wrist, hand and fingers. There are rigid cuffs with an extension to optimize the shoulder, elbow, wrist and hand angles. Shoulder position is capable of 90 degrees abduction from the torso. Adjustable rigid chest and pelvic frames or panels supports shoulder and arm components. It is used for abducting the arm away from the body and is capable of immobilizing the shoulder, elbow, wrist, and hand. It includes a soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.

Shoulder-Elbow-Wrist-Hand-Finger Orthoses

L3975 (SHOULDER ELBOW WRIST HAND FINGER ORTHOSIS, SHOULDER CAP DESIGN, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT) describes a static custom fabricated shoulder orthosis that extends from the top of the shoulder to the phalanges. This is a complete device and no add-on codes may be billed for this orthosis.

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) describes a static custom fabricated shoulder "airplane design" abduction orthosis which includes the elbow, wrist, hand and fingers. There are rigid cuffs with an extension to optimize the shoulder, elbow, wrist and hand angles. Shoulder position is capable of 90 degrees abduction from the torso. Adjustable rigid chest and pelvic frames or panels supports shoulder and arm components. It is used for abducting the arm away from the body and is capable of immobilizing the shoulder, elbow, wrist, and hand. It includes a soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.

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) describes a dynamic custom fabricated shoulder orthosis that extends from the top of the shoulder and extends to the wrist, hand and finger joints. It includes elastic bands or supportive non-torsion turnbuckles. It includes a soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.

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) describes a dynamic custom fabricated shoulder "airplane design" abduction orthosis which includes the elbow, wrist, hand and fingers. There are rigid cuffs with an extension to optimize the shoulder, elbow, wrist and hand angles. Shoulder position is capable of 90 degrees abduction from the torso. Adjustable rigid chest and pelvic frames or panels supports shoulder and arm components. It is used for abducting the arm away from the body and is capable of immobilizing the shoulder, elbow, wrist, and hand. It includes a soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.

Correct coding is an essential element for correct claim payment. The PDAC contractor maintains a variety of resources to assist suppliers in determining the appropriate code for Medicare billing. For questions about correct coding, contact the PDAC HCPCS Helpline at (877) 735-1326 during the hours of 9:30 a.m. to 5:00 p.m. ET, Monday through Friday. You may also visit the PDAC website to chat with a representative, or select the Contact Us button at the top of the PDAC website for email, FAX, or postal mail information.

Publication History

August 22, 2024	Revised L3760 information by changing "describes a dynamic prefabricated" to "describes a prefabricated" and by changing "double uprights" to "single or double uprights"; Revised L3761 information by adding "single or double uprights" and by changing "any type positioning joints on both sides of the elbow" to "any type extension/flexion control joint(s)"
November 18, 2021	Originally Published