Browse HCPCS Level II 2020 Edition

L3500 - L3595  Orthopedic Shoe Additions - Other

L3500 Orthopedic shoe addition, insole, leather short Ortho shoe add leather insol MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L3510 Orthopedic shoe addition, insole, rubber short Orthopedic shoe add rub insl MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L3520 Orthopedic shoe addition, insole, felt covered with leather short O shoe add felt w leath insl MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L3530 Orthopedic shoe addition, sole, half short Ortho shoe add half sole MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L3540 Orthopedic shoe addition, sole, full short Ortho shoe add full sole MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L3550 Orthopedic shoe addition, toe tap standard short O shoe add standard toe tap MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L3560 Orthopedic shoe addition, toe tap, horseshoe short O shoe add horseshoe toe tap MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L3570 Orthopedic shoe addition, special extension to instep (leather with eyelets) short O shoe add instep extension MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L3580 Orthopedic shoe addition, convert instep to velcro closure short O shoe add instep velcro clo MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L3590 Orthopedic shoe addition, convert firm shoe counter to soft counter short O shoe convert to sof counte MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L3595 Orthopedic shoe addition, march bar short Ortho shoe add march bar MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration