What Codes are used to bill for orthotics and prosthetics?
CMS established a coding system called the HCFA Common Procedure Coding System (HCPCS) used for billing The L codes are designated for orthotic device. The L codes provide a brief description of the device and describe whether it needs to be molded to a patient model, custom fabricated, custom fitted, or have no fitting specifications. The DME carriers describe custom fitted as when “substantial adjustments are made to a prefabricated item by a specially trained professional to meet the needs and/or unique shape of an individual patient.” Custom fabricated means the “brace is made for a specific patient starting with basic materials, including, but not limited to, plastic, metal, leather, or cloth, from his/her individualized measurements and/or pattern.” A molded-to-patient model orthosis is a particular type of custom fabricated orthosis in which an impression of the specific body part is made, and the impression is then used to make a positive model. The orthosis is molded on the po
