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March 10, 2016

Retired: Hand-Finger Orthoses - Use of CG Modifier - Revised

Joint DME MAC Publication

This replaces a previous version published April 8, 2010.

Elastic garments do not meet the statutory definition of a brace. Codes L3923 (Hand finger orthosis, 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) and L3924 (Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, off-the-shelf) include both elastic and non-elastic items.

Elastic garments may be made of a variety of materials, including but not limited to neoprene or spandex (elastane, Lycra®). If a garment made with elastic material has a rigid plastic or metal component, it is considered a non-elastic orthosis for purposes of coverage and coding.

If a hand-finger garment is made primarily of elastic material, it must be billed with code A4466 (Garment, belt, sleeve or other covering, elastic or similar stretchable material, any type, each) and not code L3923 or L3924. Claims billed with code A4466 will be denied as non-covered, no benefit category. If code L3923 or L3924 orthosis has a rigid plastic or metal component, the supplier must add the CG modifier (policy criteria applied) to the code. Claims for L3923 or L3924 billed without a CG modifier will be rejected as incorrect coding.

For questions about correct coding, contact the Pricing, Data Analysis, and Coding contractor (PDAC) at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact FormExternal website.

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