HCPCS L Codes List 2023 | HCPCSCodes.org

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L Codes

Orthotic And Prosthetic Procedures, Devices

Codes

l0112
Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated
l0113
Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment
l0120
Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar)
l0130
Cervical, flexible, thermoplastic collar, molded to patient
l0140
Cervical, semi-rigid, adjustable (plastic collar)
l0150
Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibular/occipital piece)
l0160
Cervical, semi-rigid, wire frame occipital/mandibular support, prefabricated, off-the-shelf
l0170
Cervical, collar, molded to patient model
l0172
Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf
l0174
Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf
l0180
Cervical, multiple post collar, occipital/mandibular supports, adjustable
l0190
Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars (somi, guilford, taylor types)
l0200
Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars, and thoracic extension
l0220
Thoracic, rib belt, custom fabricated
l0450
Tlso, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf
l0452
Tlso, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, custom fabricated
l0454
Tlso flexible, provides trunk support, extends from sacrococcygeal junction to above t-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
l0455
Tlso, flexible, provides trunk support, extends from sacrococcygeal junction to above t-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf
l0456
Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
l0457
Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated, off-the-shelf
l0458
Tlso, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment
l0460
Tlso, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
l0462
Tlso, triplanar control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment
l0464
Tlso, triplanar control, modular segmented spinal system, four rigid plastic shells, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment
l0466
Tlso, sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
l0467
Tlso, sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated, off-the-shelf
l0468
Tlso, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal, and coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
l0469
Tlso, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal and coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated, off-the-shelf
l0470
Tlso, triplanar control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction to scapula, lateral strength provided by pelvic, thoracic, and lateral frame pieces, rotational strength provided by subclavicular extensions, restricts gross trunk motion in sagittal, coronal, and transverse planes, provides intracavitary pressure to reduce load on the intervertebral disks, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment
l0472
Tlso, triplanar control, hyperextension, rigid anterior and lateral frame extends from symphysis pubis to sternal notch with two anterior components (one pubic and one sternal), posterior and lateral pads with straps and closures, limits spinal flexion, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment
l0480
Tlso, triplanar control, one piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated
l0482
Tlso, triplanar control, one piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated
l0484
Tlso, triplanar control, two piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated
l0486
Tlso, triplanar control, two piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated
l0488
Tlso, triplanar control, one piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, prefabricated, includes fitting and adjustment
l0490
Tlso, sagittal-coronal control, one piece rigid plastic shell, with overlapping reinforced anterior, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates at or before the t-9 vertebra, anterior extends from symphysis pubis to xiphoid, anterior opening, restricts gross trunk motion in sagittal and coronal planes, prefabricated, includes fitting and adjustment
l0491
Tlso, sagittal-coronal control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal and coronal planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment
l0492
Tlso, sagittal-coronal control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal and coronal planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment
l0621
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf
l0622
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated
l0623
Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf
l0624
Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels placed over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated
l0625
Lumbar orthosis, flexible, provides lumbar support, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf
l0626
Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
l0627
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
l0628
Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf
l0629
Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, custom fabricated
l0630
Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
l0631
Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
l0632
Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, custom fabricated
l0633
Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
l0634
Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, custom fabricated
l0635
Lumbar-sacral orthosis, sagittal-coronal control, lumbar flexion, rigid posterior frame/panel(s), lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, prefabricated, includes fitting and adjustment
l0636
Lumbar sacral orthosis, sagittal-coronal control, lumbar flexion, rigid posterior frame/panels, lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, custom fabricated
l0637
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
l0638
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, custom fabricated
l0639
Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
l0640
Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, custom fabricated
l0641
Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf
l0642
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf
l0643
Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf
l0648
Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf
l0649
Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf
l0650
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf
l0651
Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, prefabricated, off-the-shelf
l0700
Cervical-thoracic-lumbar-sacral-orthoses (ctlso), anterior-posterior-lateral control, molded to patient model, (minerva type)
l0710
Ctlso, anterior-posterior-lateral-control, molded to patient model, with interface material, (minerva type)
l0810
Halo procedure, cervical halo incorporated into jacket vest
l0820
Halo procedure, cervical halo incorporated into plaster body jacket
l0830
Halo procedure, cervical halo incorporated into milwaukee type orthosis
l0859
Addition to halo procedure, magnetic resonance image compatible systems, rings and pins, any material
l0861
Addition to halo procedure, replacement liner/interface material
l0970
Tlso, corset front
l0972
Lso, corset front
l0974
Tlso, full corset
l0976
Lso, full corset
l0978
Axillary crutch extension
l0980
Peroneal straps, prefabricated, off-the-shelf, pair
l0982
Stocking supporter grips, prefabricated, off-the-shelf, set of four (4)
l0984
Protective body sock, prefabricated, off-the-shelf, each
l0999
Addition to spinal orthosis, not otherwise specified
l1000
Cervical-thoracic-lumbar-sacral orthosis (ctlso) (milwaukee), inclusive of furnishing initial orthosis, including model
l1001
Cervical thoracic lumbar sacral orthosis, immobilizer, infant size, prefabricated, includes fitting and adjustment
l1005
Tension based scoliosis orthosis and accessory pads, includes fitting and adjustment
l1010
Addition to cervical-thoracic-lumbar-sacral orthosis (ctlso) or scoliosis orthosis, axilla sling
l1020
Addition to ctlso or scoliosis orthosis, kyphosis pad
l1025
Addition to ctlso or scoliosis orthosis, kyphosis pad, floating
l1030
Addition to ctlso or scoliosis orthosis, lumbar bolster pad
l1040
Addition to ctlso or scoliosis orthosis, lumbar or lumbar rib pad
l1050
Addition to ctlso or scoliosis orthosis, sternal pad
l1060
Addition to ctlso or scoliosis orthosis, thoracic pad
l1070
Addition to ctlso or scoliosis orthosis, trapezius sling
l1080
Addition to ctlso or scoliosis orthosis, outrigger
l1085
Addition to ctlso or scoliosis orthosis, outrigger, bilateral with vertical extensions
l1090
Addition to ctlso or scoliosis orthosis, lumbar sling
l1100
Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather
l1110
Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather, molded to patient model
l1120
Addition to ctlso, scoliosis orthosis, cover for upright, each
l1200
Thoracic-lumbar-sacral-orthosis (tlso), inclusive of furnishing initial orthosis only
l1210
Addition to tlso, (low profile), lateral thoracic extension
l1220
Addition to tlso, (low profile), anterior thoracic extension
l1230
Addition to tlso, (low profile), milwaukee type superstructure
l1240
Addition to tlso, (low profile), lumbar derotation pad
l1250
Addition to tlso, (low profile), anterior asis pad
l1260
Addition to tlso, (low profile), anterior thoracic derotation pad
l1270
Addition to tlso, (low profile), abdominal pad
l1280
Addition to tlso, (low profile), rib gusset (elastic), each
l1290
Addition to tlso, (low profile), lateral trochanteric pad
l1300
Other scoliosis procedure, body jacket molded to patient model
l1310
Other scoliosis procedure, post-operative body jacket
l1499
Spinal orthosis, not otherwise specified
l1600
Hip orthosis, abduction control of hip joints, flexible, frejka type with cover, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an inidividual with expertise
l1610
Hip orthosis, abduction control of hip joints, flexible, (frejka cover only), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
l1620
Hip orthosis, abduction control of hip joints, flexible, (pavlik harness), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
l1630
Hip orthosis, abduction control of hip joints, semi-flexible (von rosen type), custom fabricated
l1640
Hip orthosis, abduction control of hip joints, static, pelvic band or spreader bar, thigh cuffs, custom fabricated
l1650
Hip orthosis, abduction control of hip joints, static, adjustable, (ilfled type), prefabricated, includes fitting and adjustment
l1652
Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, includes fitting and adjustment, any type
l1660
Hip orthosis, abduction control of hip joints, static, plastic, prefabricated, includes fitting and adjustment
l1680
Hip orthosis, abduction control of hip joints, dynamic, pelvic control, adjustable hip motion control, thigh cuffs (rancho hip action type), custom fabricated
l1685
Hip orthosis, abduction control of hip joint, postoperative hip abduction type, custom fabricated
l1686
Hip orthosis, abduction control of hip joint, postoperative hip abduction type, prefabricated, includes fitting and adjustment
l1690
Combination, bilateral, lumbo-sacral, hip, femur orthosis providing adduction and internal rotation control, prefabricated, includes fitting and adjustment
l1700
Legg perthes orthosis, (toronto type), custom fabricated
l1710
Legg perthes orthosis, (newington type), custom fabricated
l1720
Legg perthes orthosis, trilateral, (tachdijan type), custom fabricated
l1730
Legg perthes orthosis, (scottish rite type), custom fabricated
l1755
Legg perthes orthosis, (patten bottom type), custom fabricated
l1810
Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
l1812
Knee orthosis, elastic with joints, prefabricated, off-the-shelf
l1820
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, includes fitting and adjustment
l1830
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf
l1831
Knee orthosis, locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment
l1832
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
l1833
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf
l1834
Knee orthosis, without knee joint, rigid, custom fabricated
l1836
Knee orthosis, rigid, without joint(s), includes soft interface material, prefabricated, off-the-shelf
l1840
Knee orthosis, derotation, medial-lateral, anterior cruciate ligament, custom fabricated
l1843
Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
l1844
Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated
l1845
Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
l1846
Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated
l1847
Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
l1848
Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated, off-the-shelf
l1850
Knee orthosis, swedish type, prefabricated, off-the-shelf
l1851
Knee orthosis (ko), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf
l1852
Knee orthosis (ko), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf
l1860
Knee orthosis, modification of supracondylar prosthetic socket, custom fabricated (sk)
l1900
Ankle foot orthosis, spring wire, dorsiflexion assist calf band, custom fabricated
l1902
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf
l1904
Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated
l1906
Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf
l1907
Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated
l1910
Ankle foot orthosis, posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment
l1920
Ankle foot orthosis, single upright with static or adjustable stop (phelps or perlstein type), custom fabricated
l1930
Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment
l1932
Afo, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, includes fitting and adjustment
l1940
Ankle foot orthosis, plastic or other material, custom fabricated
l1945
Ankle foot orthosis, plastic, rigid anterior tibial section (floor reaction), custom fabricated
l1950
Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic, custom fabricated
l1951
Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, includes fitting and adjustment
l1960
Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
l1970
Ankle foot orthosis, plastic with ankle joint, custom fabricated
l1971
Ankle foot orthosis, plastic or other material with ankle joint, prefabricated, includes fitting and adjustment
l1980
Ankle foot orthosis, single upright free plantar dorsiflexion, solid stirrup, calf band/cuff (single bar 'bk' orthosis), custom fabricated
l1990
Ankle foot orthosis, double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar 'bk' orthosis), custom fabricated
l2000
Knee ankle foot orthosis, single upright, free knee, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar 'ak' orthosis), custom fabricated
l2005
Knee ankle foot orthosis, any material, single or double upright, stance control, automatic lock and swing phase release, any type activation, includes ankle joint, any type, custom fabricated
l2006
Knee ankle foot device, any material, single or double upright, swing and stance phase microprocessor control with adjustability, includes all components (e.g., sensors, batteries, charger), any type activation, with or without ankle joint(s), custom fabricated
l2010
Knee ankle foot orthosis, single upright, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar 'ak' orthosis), without knee joint, custom fabricated
l2020
Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs (double bar 'ak' orthosis), custom fabricated
l2030
Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs, (double bar 'ak' orthosis), without knee joint, custom fabricated
l2034
Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, medial lateral rotation control, with or without free motion ankle, custom fabricated
l2035
Knee ankle foot orthosis, full plastic, static (pediatric size), without free motion ankle, prefabricated, includes fitting and adjustment
l2036
Knee ankle foot orthosis, full plastic, double upright, with or without free motion knee, with or without free motion ankle, custom fabricated
l2037
Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, with or without free motion ankle, custom fabricated
l2038
Knee ankle foot orthosis, full plastic, with or without free motion knee, multi-axis ankle, custom fabricated
l2040
Hip knee ankle foot orthosis, torsion control, bilateral rotation straps, pelvic band/belt, custom fabricated
l2050
Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, hip joint, pelvic band/belt, custom fabricated
l2060
Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, ball bearing hip joint, pelvic band/ belt, custom fabricated
l2070
Hip knee ankle foot orthosis, torsion control, unilateral rotation straps, pelvic band/belt, custom fabricated
l2080
Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, hip joint, pelvic band/belt, custom fabricated
l2090
Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, ball bearing hip joint, pelvic band/ belt, custom fabricated
l2106
Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, thermoplastic type casting material, custom fabricated
l2108
Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, custom fabricated
l2112
Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment
l2114
Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment
l2116
Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, rigid, prefabricated, includes fitting and adjustment
l2126
Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, thermoplastic type casting material, custom fabricated
l2128
Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, custom fabricated
l2132
Kafo, fracture orthosis, femoral fracture cast orthosis, soft, prefabricated, includes fitting and adjustment
l2134
Kafo, fracture orthosis, femoral fracture cast orthosis, semi-rigid, prefabricated, includes fitting and adjustment
l2136
Kafo, fracture orthosis, femoral fracture cast orthosis, rigid, prefabricated, includes fitting and adjustment
l2180
Addition to lower extremity fracture orthosis, plastic shoe insert with ankle joints
l2182
Addition to lower extremity fracture orthosis, drop lock knee joint
l2184
Addition to lower extremity fracture orthosis, limited motion knee joint
l2186
Addition to lower extremity fracture orthosis, adjustable motion knee joint, lerman type
l2188
Addition to lower extremity fracture orthosis, quadrilateral brim
l2190
Addition to lower extremity fracture orthosis, waist belt
l2192
Addition to lower extremity fracture orthosis, hip joint, pelvic band, thigh flange, and pelvic belt
l2200
Addition to lower extremity, limited ankle motion, each joint
l2210
Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint
l2220
Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint
l2230
Addition to lower extremity, split flat caliper stirrups and plate attachment
l2232
Addition to lower extremity orthosis, rocker bottom for total contact ankle foot orthosis, for custom fabricated orthosis only
l2240
Addition to lower extremity, round caliper and plate attachment
l2250
Addition to lower extremity, foot plate, molded to patient model, stirrup attachment
l2260
Addition to lower extremity, reinforced solid stirrup (scott-craig type)
l2265
Addition to lower extremity, long tongue stirrup
l2270
Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad
l2275
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined
l2280
Addition to lower extremity, molded inner boot
l2300
Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
l2310
Addition to lower extremity, abduction bar-straight
l2320
Addition to lower extremity, non-molded lacer, for custom fabricated orthosis only
l2330
Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only
l2335
Addition to lower extremity, anterior swing band
l2340
Addition to lower extremity, pre-tibial shell, molded to patient model
l2350
Addition to lower extremity, prosthetic type, (bk) socket, molded to patient model, (used for 'ptb' 'afo' orthoses)
l2360
Addition to lower extremity, extended steel shank
l2370
Addition to lower extremity, patten bottom
l2375
Addition to lower extremity, torsion control, ankle joint and half solid stirrup
l2380
Addition to lower extremity, torsion control, straight knee joint, each joint
l2385
Addition to lower extremity, straight knee joint, heavy duty, each joint
l2387
Addition to lower extremity, polycentric knee joint, for custom fabricated knee ankle foot orthosis, each joint
l2390
Addition to lower extremity, offset knee joint, each joint
l2395
Addition to lower extremity, offset knee joint, heavy duty, each joint
l2397
Addition to lower extremity orthosis, suspension sleeve
l2405
Addition to knee joint, drop lock, each
l2415
Addition to knee lock with integrated release mechanism (bail, cable, or equal), any material, each joint
l2425
Addition to knee joint, disc or dial lock for adjustable knee flexion, each joint
l2430
Addition to knee joint, ratchet lock for active and progressive knee extension, each joint
l2492
Addition to knee joint, lift loop for drop lock ring
l2500
Addition to lower extremity, thigh/weight bearing, gluteal/ ischial weight bearing, ring
l2510
Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, molded to patient model
l2520
Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, custom fitted
l2525
Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim molded to patient model
l2526
Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim, custom fitted
l2530
Addition to lower extremity, thigh-weight bearing, lacer, non-molded
l2540
Addition to lower extremity, thigh/weight bearing, lacer, molded to patient model
l2550
Addition to lower extremity, thigh/weight bearing, high roll cuff
l2570
Addition to lower extremity, pelvic control, hip joint, clevis type two position joint, each
l2580
Addition to lower extremity, pelvic control, pelvic sling
l2600
Addition to lower extremity, pelvic control, hip joint, clevis type, or thrust bearing, free, each
l2610
Addition to lower extremity, pelvic control, hip joint, clevis or thrust bearing, lock, each
l2620
Addition to lower extremity, pelvic control, hip joint, heavy duty, each
l2622
Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each
l2624
Addition to lower extremity, pelvic control, hip joint, adjustable flexion, extension, abduction control, each
l2627
Addition to lower extremity, pelvic control, plastic, molded to patient model, reciprocating hip joint and cables
l2628
Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables
l2630
Addition to lower extremity, pelvic control, band and belt, unilateral
l2640
Addition to lower extremity, pelvic control, band and belt, bilateral
l2650
Addition to lower extremity, pelvic and thoracic control, gluteal pad, each
l2660
Addition to lower extremity, thoracic control, thoracic band
l2670
Addition to lower extremity, thoracic control, paraspinal uprights
l2680
Addition to lower extremity, thoracic control, lateral support uprights
l2750
Addition to lower extremity orthosis, plating chrome or nickel, per bar
l2755
Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only
l2760
Addition to lower extremity orthosis, extension, per extension, per bar (for lineal adjustment for growth)
l2768
Orthotic side bar disconnect device, per bar
l2780
Addition to lower extremity orthosis, non-corrosive finish, per bar
l2785
Addition to lower extremity orthosis, drop lock retainer, each
l2795
Addition to lower extremity orthosis, knee control, full kneecap
l2800
Addition to lower extremity orthosis, knee control, knee cap, medial or lateral pull, for use with custom fabricated orthosis only
l2810
Addition to lower extremity orthosis, knee control, condylar pad
l2820
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section
l2830
Addition to lower extremity orthosis, soft interface for molded plastic, above knee section
l2840
Addition to lower extremity orthosis, tibial length sock, fracture or equal, each
l2850
Addition to lower extremity orthosis, femoral length sock, fracture or equal, each
l2861
Addition to lower extremity joint, knee or ankle, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each
l2999
Lower extremity orthoses, not otherwise specified
l3000
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each
l3001
Foot, insert, removable, molded to patient model, spenco, each
l3002
Foot, insert, removable, molded to patient model, plastazote or equal, each
l3003
Foot, insert, removable, molded to patient model, silicone gel, each
l3010
Foot, insert, removable, molded to patient model, longitudinal arch support, each
l3020
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each
l3030
Foot, insert, removable, formed to patient foot, each
l3031
Foot, insert/plate, removable, addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, each
l3040
Foot, arch support, removable, premolded, longitudinal, each
l3050
Foot, arch support, removable, premolded, metatarsal, each
l3060
Foot, arch support, removable, premolded, longitudinal/ metatarsal, each
l3070
Foot, arch support, non-removable attached to shoe, longitudinal, each
l3080
Foot, arch support, non-removable attached to shoe, metatarsal, each
l3090
Foot, arch support, non-removable attached to shoe, longitudinal/metatarsal, each
l3100
Hallus-valgus night dynamic splint, prefabricated, off-the-shelf
l3140
Foot, abduction rotation bar, including shoes
l3150
Foot, abduction rotation bar, without shoes
l3160
Foot, adjustable shoe-styled positioning device
l3170
Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each
l3201
Orthopedic shoe, oxford with supinator or pronator, infant
l3202
Orthopedic shoe, oxford with supinator or pronator, child
l3203
Orthopedic shoe, oxford with supinator or pronator, junior
l3204
Orthopedic shoe, hightop with supinator or pronator, infant
l3206
Orthopedic shoe, hightop with supinator or pronator, child
l3207
Orthopedic shoe, hightop with supinator or pronator, junior
l3208
Surgical boot, each, infant
l3209
Surgical boot, each, child
l3211
Surgical boot, each, junior
l3212
Benesch boot, pair, infant
l3213
Benesch boot, pair, child
l3214
Benesch boot, pair, junior
l3215
Orthopedic footwear, ladies shoe, oxford, each
l3216
Orthopedic footwear, ladies shoe, depth inlay, each
l3217
Orthopedic footwear, ladies shoe, hightop, depth inlay, each
l3219
Orthopedic footwear, mens shoe, oxford, each
l3221
Orthopedic footwear, mens shoe, depth inlay, each
l3222
Orthopedic footwear, mens shoe, hightop, depth inlay, each
l3224
Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthosis)
l3225
Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis)
l3230
Orthopedic footwear, custom shoe, depth inlay, each
l3250
Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each
l3251
Foot, shoe molded to patient model, silicone shoe, each
l3252
Foot, shoe molded to patient model, plastazote (or similar), custom fabricated, each
l3253
Foot, molded shoe plastazote (or similar) custom fitted, each
l3254
Non-standard size or width
l3255
Non-standard size or length
l3257
Orthopedic footwear, additional charge for split size
l3260
Surgical boot/shoe, each
l3265
Plastazote sandal, each
l3300
Lift, elevation, heel, tapered to metatarsals, per inch
l3310
Lift, elevation, heel and sole, neoprene, per inch
l3320
Lift, elevation, heel and sole, cork, per inch
l3330
Lift, elevation, metal extension (skate)
l3332
Lift, elevation, inside shoe, tapered, up to one-half inch
l3334
Lift, elevation, heel, per inch
l3340
Heel wedge, sach
l3350
Heel wedge
l3360
Sole wedge, outside sole
l3370
Sole wedge, between sole
l3380
Clubfoot wedge
l3390
Outflare wedge
l3400
Metatarsal bar wedge, rocker
l3410
Metatarsal bar wedge, between sole
l3420
Full sole and heel wedge, between sole
l3430
Heel, counter, plastic reinforced
l3440
Heel, counter, leather reinforced
l3450
Heel, sach cushion type
l3455
Heel, new leather, standard
l3460
Heel, new rubber, standard
l3465
Heel, thomas with wedge
l3470
Heel, thomas extended to ball
l3480
Heel, pad and depression for spur
l3485
Heel, pad, removable for spur
l3500
Orthopedic shoe addition, insole, leather
l3510
Orthopedic shoe addition, insole, rubber
l3520
Orthopedic shoe addition, insole, felt covered with leather
l3530
Orthopedic shoe addition, sole, half
l3540
Orthopedic shoe addition, sole, full
l3550
Orthopedic shoe addition, toe tap standard
l3560
Orthopedic shoe addition, toe tap, horseshoe
l3570
Orthopedic shoe addition, special extension to instep (leather with eyelets)
l3580
Orthopedic shoe addition, convert instep to velcro closure
l3590
Orthopedic shoe addition, convert firm shoe counter to soft counter
l3595
Orthopedic shoe addition, march bar
l3600
Transfer of an orthosis from one shoe to another, caliper plate, existing
l3610
Transfer of an orthosis from one shoe to another, caliper plate, new
l3620
Transfer of an orthosis from one shoe to another, solid stirrup, existing
l3630
Transfer of an orthosis from one shoe to another, solid stirrup, new
l3640
Transfer of an orthosis from one shoe to another, dennis browne splint (riveton), both shoes
l3649
Orthopedic shoe, modification, addition or transfer, not otherwise specified
l3650
Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf
l3660
Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf
l3670
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf
l3671
Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
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
l3675
Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf
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
l3678
Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated, off-the-shelf
l3702
Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
l3710
Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf
l3720
Elbow orthosis, double upright with forearm/arm cuffs, free motion, custom fabricated
l3730
Elbow orthosis, double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated
l3740
Elbow orthosis, double upright with forearm/arm cuffs, adjustable position lock with active control, custom fabricated
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
l3761
Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, off-the-shelf
l3762
Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf
l3763
Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
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
l3765
Elbow wrist hand finger orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
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
l3806
Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment
l3807
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
l3808
Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment
l3809
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type
l3891
Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each
l3900
Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, wrist or finger driven, custom fabricated
l3901
Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom fabricated
l3904
Wrist hand finger orthosis, external powered, electric, custom fabricated
l3905
Wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
l3906
Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
l3908
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf
l3912
Hand finger orthosis (hfo), flexion glove with elastic finger control, prefabricated, off-the-shelf
l3913
Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
l3915
Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, 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
l3916
Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf
l3917
Hand orthosis, metacarpal fracture orthosis, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
l3918
Hand orthosis, metacarpal fracture orthosis, prefabricated, off-the-shelf
l3919
Hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
l3921
Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
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
l3924
Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, off-the-shelf
l3925
Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf
l3927
Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), without joint/spring, extension/flexion (e.g., static or ring type), may include soft interface material, prefabricated, off-the-shelf
l3929
Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
l3930
Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, off-the-shelf
l3931
Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, includes fitting and adjustment
l3933
Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment
l3935
Finger orthosis, nontorsion joint, may include soft interface, custom fabricated, includes fitting and adjustment
l3956
Addition of joint to upper extremity orthosis, any material; per joint
l3960
Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment
l3961
Shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
l3962
Shoulder elbow wrist hand orthosis, abduction positioning, erb's palsey design, prefabricated, includes fitting and adjustment
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
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
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
l3975
Shoulder elbow wrist hand finger orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
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
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
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
l3980
Upper extremity fracture orthosis, humeral, prefabricated, includes fitting and adjustment
l3981
Upper extremity fracture orthosis, humeral, prefabricated, includes shoulder cap design, with or without joints, forearm section, may include soft interface, straps, includes fitting and adjustments
l3982
Upper extremity fracture orthosis, radius/ulnar, prefabricated, includes fitting and adjustment
l3984
Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment
l3995
Addition to upper extremity orthosis, sock, fracture or equal, each
l3999
Upper limb orthosis, not otherwise specified
l4000
Replace girdle for spinal orthosis (ctlso or so)
l4002
Replacement strap, any orthosis, includes all components, any length, any type
l4010
Replace trilateral socket brim
l4020
Replace quadrilateral socket brim, molded to patient model
l4030
Replace quadrilateral socket brim, custom fitted
l4040
Replace molded thigh lacer, for custom fabricated orthosis only
l4045
Replace non-molded thigh lacer, for custom fabricated orthosis only
l4050
Replace molded calf lacer, for custom fabricated orthosis only
l4055
Replace non-molded calf lacer, for custom fabricated orthosis only
l4060
Replace high roll cuff
l4070
Replace proximal and distal upright for kafo
l4080
Replace metal bands kafo, proximal thigh
l4090
Replace metal bands kafo-afo, calf or distal thigh
l4100
Replace leather cuff kafo, proximal thigh
l4110
Replace leather cuff kafo-afo, calf or distal thigh
l4130
Replace pretibial shell
l4205
Repair of orthotic device, labor component, per 15 minutes
l4210
Repair of orthotic device, repair or replace minor parts
l4350
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf
l4360
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
l4361
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf
l4370
Pneumatic full leg splint, prefabricated, off-the-shelf
l4386
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
l4387
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf
l4392
Replacement, soft interface material, static afo
l4394
Replace soft interface material, foot drop splint
l4396
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
l4397
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf
l4398
Foot drop splint, recumbent positioning device, prefabricated, off-the-shelf
l4631
Ankle foot orthosis, walking boot type, varus/valgus correction, rocker bottom, anterior tibial shell, soft interface, custom arch support, plastic or other material, includes straps and closures, custom fabricated
l5000
Partial foot, shoe insert with longitudinal arch, toe filler
l5010
Partial foot, molded socket, ankle height, with toe filler
l5020
Partial foot, molded socket, tibial tubercle height, with toe filler
l5050
Ankle, symes, molded socket, sach foot
l5060
Ankle, symes, metal frame, molded leather socket, articulated ankle/foot
l5100
Below knee, molded socket, shin, sach foot
l5105
Below knee, plastic socket, joints and thigh lacer, sach foot
l5150
Knee disarticulation (or through knee), molded socket, external knee joints, shin, sach foot
l5160
Knee disarticulation (or through knee), molded socket, bent knee configuration, external knee joints, shin, sach foot
l5200
Above knee, molded socket, single axis constant friction knee, shin, sach foot
l5210
Above knee, short prosthesis, no knee joint ('stubbies'), with foot blocks, no ankle joints, each
l5220
Above knee, short prosthesis, no knee joint ('stubbies'), with articulated ankle/foot, dynamically aligned, each
l5230
Above knee, for proximal femoral focal deficiency, constant friction knee, shin, sach foot
l5250
Hip disarticulation, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot
l5270
Hip disarticulation, tilt table type; molded socket, locking hip joint, single axis constant friction knee, shin, sach foot
l5280
Hemipelvectomy, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot
l5301
Below knee, molded socket, shin, sach foot, endoskeletal system
l5312
Knee disarticulation (or through knee), molded socket, single axis knee, pylon, sach foot, endoskeletal system
l5321
Above knee, molded socket, open end, sach foot, endoskeletal system, single axis knee
l5331
Hip disarticulation, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot
l5341
Hemipelvectomy, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot
l5400
Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment, suspension, and one cast change, below knee
l5410
Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension, below knee, each additional cast change and realignment
l5420
Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension and one cast change 'ak' or knee disarticulation
l5430
Immediate post surgical or early fitting, application of initial rigid dressing, incl. fitting, alignment and supension, 'ak' or knee disarticulation, each additional cast change and realignment
l5450
Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, below knee
l5460
Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, above knee
l5500
Initial, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed
l5505
Initial, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed
l5510
Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model
l5520
Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed
l5530
Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model
l5535
Preparatory, below knee 'ptb' type socket, non-alignable system, no cover, sach foot, prefabricated, adjustable open end socket
l5540
Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, laminated socket, molded to model
l5560
Preparatory, above knee- knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model
l5570
Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed
l5580
Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model
l5585
Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, prefabricated adjustable open end socket
l5590
Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon no cover, sach foot, laminated socket, molded to model
l5595
Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, thermoplastic or equal, molded to patient model
l5600
Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, laminated socket, molded to patient model
l5610
Addition to lower extremity, endoskeletal system, above knee, hydracadence system
l5611
Addition to lower extremity, endoskeletal system, above knee - knee disarticulation, 4 bar linkage, with friction swing phase control
l5613
Addition to lower extremity, endoskeletal system, above knee-knee disarticulation, 4 bar linkage, with hydraulic swing phase control
l5614
Addition to lower extremity, exoskeletal system, above knee-knee disarticulation, 4 bar linkage, with pneumatic swing phase control
l5616
Addition to lower extremity, endoskeletal system, above knee, universal multiplex system, friction swing phase control
l5617
Addition to lower extremity, quick change self-aligning unit, above knee or below knee, each
l5618
Addition to lower extremity, test socket, symes
l5620
Addition to lower extremity, test socket, below knee
l5622
Addition to lower extremity, test socket, knee disarticulation
l5624
Addition to lower extremity, test socket, above knee
l5626
Addition to lower extremity, test socket, hip disarticulation
l5628
Addition to lower extremity, test socket, hemipelvectomy
l5629
Addition to lower extremity, below knee, acrylic socket
l5630
Addition to lower extremity, symes type, expandable wall socket
l5631
Addition to lower extremity, above knee or knee disarticulation, acrylic socket
l5632
Addition to lower extremity, symes type, 'ptb' brim design socket
l5634
Addition to lower extremity, symes type, posterior opening (canadian) socket
l5636
Addition to lower extremity, symes type, medial opening socket
l5637
Addition to lower extremity, below knee, total contact
l5638
Addition to lower extremity, below knee, leather socket
l5639
Addition to lower extremity, below knee, wood socket
l5640
Addition to lower extremity, knee disarticulation, leather socket
l5642
Addition to lower extremity, above knee, leather socket
l5643
Addition to lower extremity, hip disarticulation, flexible inner socket, external frame
l5644
Addition to lower extremity, above knee, wood socket
l5645
Addition to lower extremity, below knee, flexible inner socket, external frame
l5646
Addition to lower extremity, below knee, air, fluid, gel or equal, cushion socket
l5647
Addition to lower extremity, below knee suction socket
l5648
Addition to lower extremity, above knee, air, fluid, gel or equal, cushion socket
l5649
Addition to lower extremity, ischial containment/narrow m-l socket
l5650
Additions to lower extremity, total contact, above knee or knee disarticulation socket
l5651
Addition to lower extremity, above knee, flexible inner socket, external frame
l5652
Addition to lower extremity, suction suspension, above knee or knee disarticulation socket
l5653
Addition to lower extremity, knee disarticulation, expandable wall socket
l5654
Addition to lower extremity, socket insert, symes, (kemblo, pelite, aliplast, plastazote or equal)
l5655
Addition to lower extremity, socket insert, below knee (kemblo, pelite, aliplast, plastazote or equal)
l5656
Addition to lower extremity, socket insert, knee disarticulation (kemblo, pelite, aliplast, plastazote or equal)
l5658
Addition to lower extremity, socket insert, above knee (kemblo, pelite, aliplast, plastazote or equal)
l5661
Addition to lower extremity, socket insert, multi-durometer symes
l5665
Addition to lower extremity, socket insert, multi-durometer, below knee
l5666
Addition to lower extremity, below knee, cuff suspension
l5668
Addition to lower extremity, below knee, molded distal cushion
l5670
Addition to lower extremity, below knee, molded supracondylar suspension ('pts' or similar)
l5671
Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert
l5672
Addition to lower extremity, below knee, removable medial brim suspension
l5673
Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism
l5676
Additions to lower extremity, below knee, knee joints, single axis, pair
l5677
Additions to lower extremity, below knee, knee joints, polycentric, pair
l5678
Additions to lower extremity, below knee, joint covers, pair
l5679
Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism
l5680
Addition to lower extremity, below knee, thigh lacer, nonmolded
l5681
Addition to lower extremity, below knee/above knee, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l5673 or l5679)
l5682
Addition to lower extremity, below knee, thigh lacer, gluteal/ischial, molded
l5683
Addition to lower extremity, below knee/above knee, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l5673 or l5679)
l5684
Addition to lower extremity, below knee, fork strap
l5685
Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each
l5686
Addition to lower extremity, below knee, back check (extension control)
l5688
Addition to lower extremity, below knee, waist belt, webbing
l5690
Addition to lower extremity, below knee, waist belt, padded and lined
l5692
Addition to lower extremity, above knee, pelvic control belt, light
l5694
Addition to lower extremity, above knee, pelvic control belt, padded and lined
l5695
Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each
l5696
Addition to lower extremity, above knee or knee disarticulation, pelvic joint
l5697
Addition to lower extremity, above knee or knee disarticulation, pelvic band
l5698
Addition to lower extremity, above knee or knee disarticulation, silesian bandage
l5699
All lower extremity prostheses, shoulder harness
l5700
Replacement, socket, below knee, molded to patient model
l5701
Replacement, socket, above knee/knee disarticulation, including attachment plate, molded to patient model
l5702
Replacement, socket, hip disarticulation, including hip joint, molded to patient model
l5703
Ankle, symes, molded to patient model, socket without solid ankle cushion heel (sach) foot, replacement only
l5704
Custom shaped protective cover, below knee
l5705
Custom shaped protective cover, above knee
l5706
Custom shaped protective cover, knee disarticulation
l5707
Custom shaped protective cover, hip disarticulation
l5710
Addition, exoskeletal knee-shin system, single axis, manual lock
l5711
Additions exoskeletal knee-shin system, single axis, manual lock, ultra-light material
l5712
Addition, exoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)
l5714
Addition, exoskeletal knee-shin system, single axis, variable friction swing phase control
l5716
Addition, exoskeletal knee-shin system, polycentric, mechanical stance phase lock
l5718
Addition, exoskeletal knee-shin system, polycentric, friction swing and stance phase control
l5722
Addition, exoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control
l5724
Addition, exoskeletal knee-shin system, single axis, fluid swing phase control
l5726
Addition, exoskeletal knee-shin system, single axis, external joints fluid swing phase control
l5728
Addition, exoskeletal knee-shin system, single axis, fluid swing and stance phase control
l5780
Addition, exoskeletal knee-shin system, single axis, pneumatic/hydra pneumatic swing phase control
l5781
Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system
l5782
Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy duty
l5785
Addition, exoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)
l5790
Addition, exoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)
l5795
Addition, exoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)
l5810
Addition, endoskeletal knee-shin system, single axis, manual lock
l5811
Addition, endoskeletal knee-shin system, single axis, manual lock, ultra-light material
l5812
Addition, endoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)
l5814
Addition, endoskeletal knee-shin system, polycentric, hydraulic swing phase control, mechanical stance phase lock
l5816
Addition, endoskeletal knee-shin system, polycentric, mechanical stance phase lock
l5818
Addition, endoskeletal knee-shin system, polycentric, friction swing, and stance phase control
l5822
Addition, endoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control
l5824
Addition, endoskeletal knee-shin system, single axis, fluid swing phase control
l5826
Addition, endoskeletal knee-shin system, single axis, hydraulic swing phase control, with miniature high activity frame
l5828
Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control
l5830
Addition, endoskeletal knee-shin system, single axis, pneumatic/ swing phase control
l5840
Addition, endoskeletal knee/shin system, 4-bar linkage or multiaxial, pneumatic swing phase control
l5845
Addition, endoskeletal, knee-shin system, stance flexion feature, adjustable
l5848
Addition to endoskeletal knee-shin system, fluid stance extension, dampening feature, with or without adjustability
l5850
Addition, endoskeletal system, above knee or hip disarticulation, knee extension assist
l5855
Addition, endoskeletal system, hip disarticulation, mechanical hip extension assist
l5856
Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type
l5857
Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type
l5858
Addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type
l5859
Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s)
l5910
Addition, endoskeletal system, below knee, alignable system
l5920
Addition, endoskeletal system, above knee or hip disarticulation, alignable system
l5925
Addition, endoskeletal system, above knee, knee disarticulation or hip disarticulation, manual lock
l5930
Addition, endoskeletal system, high activity knee control frame
l5940
Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)
l5950
Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)
l5960
Addition, endoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)
l5961
Addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion and/or extension control
l5962
Addition, endoskeletal system, below knee, flexible protective outer surface covering system
l5964
Addition, endoskeletal system, above knee, flexible protective outer surface covering system
l5966
Addition, endoskeletal system, hip disarticulation, flexible protective outer surface covering system
l5968
Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature
l5969
Addition, endoskeletal ankle-foot or ankle system, power assist, includes any type motor(s)
l5970
All lower extremity prostheses, foot, external keel, sach foot
l5971
All lower extremity prosthesis, solid ankle cushion heel (sach) foot, replacement only
l5972
All lower extremity prostheses, foot, flexible keel
l5973
Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source
l5974
All lower extremity prostheses, foot, single axis ankle/foot
l5975
All lower extremity prosthesis, combination single axis ankle and flexible keel foot
l5976
All lower extremity prostheses, energy storing foot (seattle carbon copy ii or equal)
l5978
All lower extremity prostheses, foot, multiaxial ankle/foot
l5979
All lower extremity prosthesis, multi-axial ankle, dynamic response foot, one piece system
l5980
All lower extremity prostheses, flex foot system
l5981
All lower extremity prostheses, flex-walk system or equal
l5982
All exoskeletal lower extremity prostheses, axial rotation unit
l5984
All endoskeletal lower extremity prosthesis, axial rotation unit, with or without adjustability
l5985
All endoskeletal lower extremity prostheses, dynamic prosthetic pylon
l5986
All lower extremity prostheses, multi-axial rotation unit ('mcp' or equal)
l5987
All lower extremity prosthesis, shank foot system with vertical loading pylon
l5988
Addition to lower limb prosthesis, vertical shock reducing pylon feature
l5990
Addition to lower extremity prosthesis, user adjustable heel height
l5999
Lower extremity prosthesis, not otherwise specified
l6000
Partial hand, thumb remaining
l6010
Partial hand, little and/or ring finger remaining
l6020
Partial hand, no finger remaining
l6025
Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectric control of terminal device
l6026
Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectric control of terminal device, excludes terminal device(s)
l6050
Wrist disarticulation, molded socket, flexible elbow hinges, triceps pad
l6055
Wrist disarticulation, molded socket with expandable interface, flexible elbow hinges, triceps pad
l6100
Below elbow, molded socket, flexible elbow hinge, triceps pad
l6110
Below elbow, molded socket, (muenster or northwestern suspension types)
l6120
Below elbow, molded double wall split socket, step-up hinges, half cuff
l6130
Below elbow, molded double wall split socket, stump activated locking hinge, half cuff
l6200
Elbow disarticulation, molded socket, outside locking hinge, forearm
l6205
Elbow disarticulation, molded socket with expandable interface, outside locking hinges, forearm
l6250
Above elbow, molded double wall socket, internal locking elbow, forearm
l6300
Shoulder disarticulation, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm
l6310
Shoulder disarticulation, passive restoration (complete prosthesis)
l6320
Shoulder disarticulation, passive restoration (shoulder cap only)
l6350
Interscapular thoracic, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm
l6360
Interscapular thoracic, passive restoration (complete prosthesis)
l6370
Interscapular thoracic, passive restoration (shoulder cap only)
l6380
Immediate post surgical or early fitting, application of initial rigid dressing, including fitting alignment and suspension of components, and one cast change, wrist disarticulation or below elbow
l6382
Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, elbow disarticulation or above elbow
l6384
Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, shoulder disarticulation or interscapular thoracic
l6386
Immediate post surgical or early fitting, each additional cast change and realignment
l6388
Immediate post surgical or early fitting, application of rigid dressing only
l6400
Below elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping
l6450
Elbow disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping
l6500
Above elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping
l6550
Shoulder disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping
l6570
Interscapular thoracic, molded socket, endoskeletal system, including soft prosthetic tissue shaping
l6580
Preparatory, wrist disarticulation or below elbow, single wall plastic socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden cable control, usmc or equal pylon, no cover, molded to patient model
l6582
Preparatory, wrist disarticulation or below elbow, single wall socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden cable control, usmc or equal pylon, no cover, direct formed
l6584
Preparatory, elbow disarticulation or above elbow, single wall plastic socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or equal pylon, no cover, molded to patient model
l6586
Preparatory, elbow disarticulation or above elbow, single wall socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or equal pylon, no cover, direct formed
l6588
Preparatory, shoulder disarticulation or interscapular thoracic, single wall plastic socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, usmc or equal pylon, no cover, molded to patient model
l6590
Preparatory, shoulder disarticulation or interscapular thoracic, single wall socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, usmc or equal pylon, no cover, direct formed
l6600
Upper extremity additions, polycentric hinge, pair
l6605
Upper extremity additions, single pivot hinge, pair
l6610
Upper extremity additions, flexible metal hinge, pair
l6611
Addition to upper extremity prosthesis, external powered, additional switch, any type
l6615
Upper extremity addition, disconnect locking wrist unit
l6616
Upper extremity addition, additional disconnect insert for locking wrist unit, each
l6620
Upper extremity addition, flexion/extension wrist unit, with or without friction
l6621
Upper extremity prosthesis addition, flexion/extension wrist with or without friction, for use with external powered terminal device
l6623
Upper extremity addition, spring assisted rotational wrist unit with latch release
l6624
Upper extremity addition, flexion/extension and rotation wrist unit
l6625
Upper extremity addition, rotation wrist unit with cable lock
l6628
Upper extremity addition, quick disconnect hook adapter, otto bock or equal
l6629
Upper extremity addition, quick disconnect lamination collar with coupling piece, otto bock or equal
l6630
Upper extremity addition, stainless steel, any wrist
l6632
Upper extremity addition, latex suspension sleeve, each
l6635
Upper extremity addition, lift assist for elbow
l6637
Upper extremity addition, nudge control elbow lock
l6638
Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow
l6640
Upper extremity additions, shoulder abduction joint, pair
l6641
Upper extremity addition, excursion amplifier, pulley type
l6642
Upper extremity addition, excursion amplifier, lever type
l6645
Upper extremity addition, shoulder flexion-abduction joint, each
l6646
Upper extremity addition, shoulder joint, multipositional locking, flexion, adjustable abduction friction control, for use with body powered or external powered system
l6647
Upper extremity addition, shoulder lock mechanism, body powered actuator
l6648
Upper extremity addition, shoulder lock mechanism, external powered actuator
l6650
Upper extremity addition, shoulder universal joint, each
l6655
Upper extremity addition, standard control cable, extra
l6660
Upper extremity addition, heavy duty control cable
l6665
Upper extremity addition, teflon, or equal, cable lining
l6670
Upper extremity addition, hook to hand, cable adapter
l6672
Upper extremity addition, harness, chest or shoulder, saddle type
l6675
Upper extremity addition, harness, (e.g., figure of eight type), single cable design
l6676
Upper extremity addition, harness, (e.g., figure of eight type), dual cable design
l6677
Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow
l6680
Upper extremity addition, test socket, wrist disarticulation or below elbow
l6682
Upper extremity addition, test socket, elbow disarticulation or above elbow
l6684
Upper extremity addition, test socket, shoulder disarticulation or interscapular thoracic
l6686
Upper extremity addition, suction socket
l6687
Upper extremity addition, frame type socket, below elbow or wrist disarticulation
l6688
Upper extremity addition, frame type socket, above elbow or elbow disarticulation
l6689
Upper extremity addition, frame type socket, shoulder disarticulation
l6690
Upper extremity addition, frame type socket, interscapular-thoracic
l6691
Upper extremity addition, removable insert, each
l6692
Upper extremity addition, silicone gel insert or equal, each
l6693
Upper extremity addition, locking elbow, forearm counterbalance
l6694
Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism
l6695
Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism
l6696
Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695)
l6697
Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695)
l6698
Addition to upper extremity prosthesis, below elbow/above elbow, lock mechanism, excludes socket insert
l6703
Terminal device, passive hand/mitt, any material, any size
l6704
Terminal device, sport/recreational/work attachment, any material, any size
l6706
Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined
l6707
Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined
l6708
Terminal device, hand, mechanical, voluntary opening, any material, any size
l6709
Terminal device, hand, mechanical, voluntary closing, any material, any size
l6711
Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined, pediatric
l6712
Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined, pediatric
l6713
Terminal device, hand, mechanical, voluntary opening, any material, any size, pediatric
l6714
Terminal device, hand, mechanical, voluntary closing, any material, any size, pediatric
l6715
Terminal device, multiple articulating digit, includes motor(s), initial issue or replacement
l6721
Terminal device, hook or hand, heavy duty, mechanical, voluntary opening, any material, any size, lined or unlined
l6722
Terminal device, hook or hand, heavy duty, mechanical, voluntary closing, any material, any size, lined or unlined
l6805
Addition to terminal device, modifier wrist unit
l6810
Addition to terminal device, precision pinch device
l6880
Electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s)
l6881
Automatic grasp feature, addition to upper limb electric prosthetic terminal device
l6882
Microprocessor control feature, addition to upper limb prosthetic terminal device
l6883
Replacement socket, below elbow/wrist disarticulation, molded to patient model, for use with or without external power
l6884
Replacement socket, above elbow/elbow disarticulation, molded to patient model, for use with or without external power
l6885
Replacement socket, shoulder disarticulation/interscapular thoracic, molded to patient model, for use with or without external power
l6890
Addition to upper extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment
l6895
Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated
l6900
Hand restoration (casts, shading and measurements included), partial hand, with glove, thumb or one finger remaining
l6905
Hand restoration (casts, shading and measurements included), partial hand, with glove, multiple fingers remaining
l6910
Hand restoration (casts, shading and measurements included), partial hand, with glove, no fingers remaining
l6915
Hand restoration (shading, and measurements included), replacement glove for above
l6920
Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal, switch, cables, two batteries and one charger, switch control of terminal device
l6925
Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device
l6930
Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device
l6935
Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device
l6940
Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device
l6945
Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device
l6950
Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device
l6955
Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device
l6960
Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device
l6965
Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device
l6970
Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device
l6975
Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device
l7007
Electric hand, switch or myoelectric controlled, adult
l7008
Electric hand, switch or myoelectric, controlled, pediatric
l7009
Electric hook, switch or myoelectric controlled, adult
l7040
Prehensile actuator, switch controlled
l7045
Electric hook, switch or myoelectric controlled, pediatric
l7170
Electronic elbow, hosmer or equal, switch controlled
l7180
Electronic elbow, microprocessor sequential control of elbow and terminal device
l7181
Electronic elbow, microprocessor simultaneous control of elbow and terminal device
l7185
Electronic elbow, adolescent, variety village or equal, switch controlled
l7186
Electronic elbow, child, variety village or equal, switch controlled
l7190
Electronic elbow, adolescent, variety village or equal, myoelectronically controlled
l7191
Electronic elbow, child, variety village or equal, myoelectronically controlled
l7259
Electronic wrist rotator, any type
l7260
Electronic wrist rotator, otto bock or equal
l7261
Electronic wrist rotator, for utah arm
l7360
Six volt battery, each
l7362
Battery charger, six volt, each
l7364
Twelve volt battery, each
l7366
Battery charger, twelve volt, each
l7367
Lithium ion battery, rechargeable, replacement
l7368
Lithium ion battery charger, replacement only
l7400
Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultralight material (titanium, carbon fiber or equal)
l7401
Addition to upper extremity prosthesis, above elbow disarticulation, ultralight material (titanium, carbon fiber or equal)
l7402
Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultralight material (titanium, carbon fiber or equal)
l7403
Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material
l7404
Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material
l7405
Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material
l7499
Upper extremity prosthesis, not otherwise specified
l7510
Repair of prosthetic device, repair or replace minor parts
l7520
Repair prosthetic device, labor component, per 15 minutes
l7600
Prosthetic donning sleeve, any material, each
l7700
Gasket or seal, for use with prosthetic socket insert, any type, each
l7900
Male vacuum erection system
l7902
Tension ring, for vacuum erection device, any type, replacement only, each
l8000
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type
l8001
Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type
l8002
Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type
l8010
Breast prosthesis, mastectomy sleeve
l8015
External breast prosthesis garment, with mastectomy form, post mastectomy
l8020
Breast prosthesis, mastectomy form
l8030
Breast prosthesis, silicone or equal, without integral adhesive
l8031
Breast prosthesis, silicone or equal, with integral adhesive
l8032
Nipple prosthesis, prefabricated, reusable, any type, each
l8033
Nipple prosthesis, custom fabricated, reusable, any material, any type, each
l8035
Custom breast prosthesis, post mastectomy, molded to patient model
l8039
Breast prosthesis, not otherwise specified
l8040
Nasal prosthesis, provided by a non-physician
l8041
Midfacial prosthesis, provided by a non-physician
l8042
Orbital prosthesis, provided by a non-physician
l8043
Upper facial prosthesis, provided by a non-physician
l8044
Hemi-facial prosthesis, provided by a non-physician
l8045
Auricular prosthesis, provided by a non-physician
l8046
Partial facial prosthesis, provided by a non-physician
l8047
Nasal septal prosthesis, provided by a non-physician
l8048
Unspecified maxillofacial prosthesis, by report, provided by a non-physician
l8049
Repair or modification of maxillofacial prosthesis, labor component, 15 minute increments, provided by a non-physician
l8300
Truss, single with standard pad
l8310
Truss, double with standard pads
l8320
Truss, addition to standard pad, water pad
l8330
Truss, addition to standard pad, scrotal pad
l8400
Prosthetic sheath, below knee, each
l8410
Prosthetic sheath, above knee, each
l8415
Prosthetic sheath, upper limb, each
l8417
Prosthetic sheath/sock, including a gel cushion layer, below knee or above knee, each
l8420
Prosthetic sock, multiple ply, below knee, each
l8430
Prosthetic sock, multiple ply, above knee, each
l8435
Prosthetic sock, multiple ply, upper limb, each
l8440
Prosthetic shrinker, below knee, each
l8460
Prosthetic shrinker, above knee, each
l8465
Prosthetic shrinker, upper limb, each
l8470
Prosthetic sock, single ply, fitting, below knee, each
l8480
Prosthetic sock, single ply, fitting, above knee, each
l8485
Prosthetic sock, single ply, fitting, upper limb, each
l8499
Unlisted procedure for miscellaneous prosthetic services
l8500
Artificial larynx, any type
l8501
Tracheostomy speaking valve
l8505
Artificial larynx replacement battery / accessory, any type
l8507
Tracheo-esophageal voice prosthesis, patient inserted, any type, each
l8509
Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type
l8510
Voice amplifier
l8511
Insert for indwelling tracheoesophageal prosthesis, with or without valve, replacement only, each
l8512
Gelatin capsules or equivalent, for use with tracheoesophageal voice prosthesis, replacement only, per 10
l8513
Cleaning device used with tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each
l8514
Tracheoesophageal puncture dilator, replacement only, each
l8515
Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each
l8600
Implantable breast prosthesis, silicone or equal
l8603
Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies
l8604
Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, urinary tract, 1 ml, includes shipping and necessary supplies
l8605
Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, anal canal, 1 ml, includes shipping and necessary supplies
l8606
Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe, includes shipping and necessary supplies
l8607
Injectable bulking agent for vocal cord medialization, 0.1 ml, includes shipping and necessary supplies
l8608
Miscellaneous external component, supply or accessory for use with the argus ii retinal prosthesis system
l8609
Artificial cornea
l8610
Ocular implant
l8612
Aqueous shunt
l8613
Ossicula implant
l8614
Cochlear device, includes all internal and external components
l8615
Headset/headpiece for use with cochlear implant device, replacement
l8616
Microphone for use with cochlear implant device, replacement
l8617
Transmitting coil for use with cochlear implant device, replacement
l8618
Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement
l8619
Cochlear implant, external speech processor and controller, integrated system, replacement
l8621
Zinc air battery for use with cochlear implant device and auditory osseointegrated sound processors, replacement, each
l8622
Alkaline battery for use with cochlear implant device, any size, replacement, each
l8623
Lithium ion battery for use with cochlear implant device speech processor, other than ear level, replacement, each
l8624
Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement, each
l8625
External recharging system for battery for use with cochlear implant or auditory osseointegrated device, replacement only, each
l8627
Cochlear implant, external speech processor, component, replacement
l8628
Cochlear implant, external controller component, replacement
l8629
Transmitting coil and cable, integrated, for use with cochlear implant device, replacement
l8630
Metacarpophalangeal joint implant
l8631
Metacarpal phalangeal joint replacement, two or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon), for surgical implantation (all sizes, includes entire system)
l8641
Metatarsal joint implant
l8642
Hallux implant
l8658
Interphalangeal joint spacer, silicone or equal, each
l8659
Interphalangeal finger joint replacement, 2 or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon) for surgical implantation, any size
l8670
Vascular graft material, synthetic, implant
l8679
Implantable neurostimulator, pulse generator, any type
l8680
Implantable neurostimulator electrode, each
l8681
Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only
l8682
Implantable neurostimulator radiofrequency receiver
l8683
Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver
l8684
Radiofrequency transmitter (external) for use with implantable sacral root neurostimulator receiver for bowel and bladder management, replacement
l8685
Implantable neurostimulator pulse generator, single array, rechargeable, includes extension
l8686
Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension
l8687
Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension
l8688
Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension
l8689
External recharging system for battery (internal) for use with implantable neurostimulator, replacement only
l8690
Auditory osseointegrated device, includes all internal and external components
l8691
Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each
l8692
Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment
l8693
Auditory osseointegrated device abutment, any length, replacement only
l8694
Auditory osseointegrated device, transducer/actuator, replacement only, each
l8695
External recharging system for battery (external) for use with implantable neurostimulator, replacement only
l8696
Antenna (external) for use with implantable diaphragmatic/phrenic nerve stimulation device, replacement, each
l8698
Miscellaneous component, supply or accessory for use with total artificial heart system
l8699
Prosthetic implant, not otherwise specified
l8701
Powered upper extremity range of motion assist device, elbow, wrist, hand with single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated
l8702
Powered upper extremity range of motion assist device, elbow, wrist, hand, finger, single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated
l9900
Orthotic and prosthetic supply, accessory, and/or service component of another hcpcs "l" code

L Codes

Codes

l0112

l0113

l0120

l0130

l0140

l0150

l0160

l0170

l0172

l0174

l0180

l0190

l0200

l0220

l0450

l0452

l0454

l0455

l0456

l0457

l0458

l0460

l0462

l0464

l0466

l0467

l0468

l0469

l0470

l0472

l0480

l0482

l0484

l0486

l0488

l0490

l0491

l0492

l0621

l0622

l0623

l0624

l0625

l0626

l0627

l0628

l0629

l0630

l0631

l0632

l0633

l0634

l0635

l0636

l0637

l0638

l0639

l0640

l0641

l0642

l0643

l0648

l0649

l0650

l0651

l0700

l0710

l0810

l0820

l0830

l0859

l0861

l0970

l0972

l0974

l0976

l0978

l0980