Browse HCPCS Level II 2020 Edition

HCPCS Level II Table of Contents

L3702 - L3766  Elbow Orthotic

L3702
Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
shortEo w/o joints cf
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L3710
Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf
shortEo elas w/metal jnts pre ots
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L3720
Elbow orthosis, double upright with forearm/arm cuffs, free motion, custom fabricated
shortForearm/arm cuffs free motio
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L3730
Elbow orthosis, double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated
shortForearm/arm cuffs ext/flex a
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L3740
Elbow orthosis, double upright with forearm/arm cuffs, adjustable position lock with active control, custom fabricated
shortCuffs adj lock w/ active con
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
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
shortEo adj jt prefab custom fit
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L3761
Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, off-the-shelf
shortEo, adj lock joint prefab ot
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L3762
Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf
shortEo rigid w/o joints pre ots
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L3763
Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
shortEwho rigid w/o jnts cf
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
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
shortEwho w/joint(s) cf
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L3765
Elbow wrist hand finger orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
shortEwhfo rigid w/o jnts cf
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
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
shortEwhfo w/joint(s) cf
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration