07/03/2017
Proper CPT Code for Custom-Made Orthotics-Non UCBL
What is the proper CPT L code for custom-made orthotics(non UCBL)? Example diagnosis plantar fasciitis. Thank you
Below are possible HCPCS codes from the pedorthic foot care association regarding the differences between the three types of custom inserts, excluding the UCB type (http://www.pedorthics.org/page/LCODEFOC052813/L-Code-Foot-Orthotic-Clarification.htm):
- L3010: Prescription Custom Fabricated Foot insert, each, removable. This type of device is fabricated from a three dimensional model of the patient’s own foot (e.g. cast, foam impression, or virtual true 3-D digital image). This type of orthotic is an accommodative/functional device, which has minimal to no heel cup and is intended to control the forefoot through a longitudinal arch support. It may also have an intrinsic or extrinsic posts designed to control foot motion. This device is made of a sufficiently rigid material to reduce pathological forces. HCPCS code L3010 includes additions such as postings, padded top covers, soft tissue supplements, balance padding and lesion or structure accommodations. Other additions may be required as well.
- L3020: Prescription Custom Fabricated Foot insert, each, removable. This type of device is fabricated from a three dimensional model of the patient’s own foot (e.g. cast, foam impression, or virtual true 3-D digital image). This type of orthotic is an accommodative/functional device, which has minimal to no heel cup and is intended to control the forefoot through a Longitudinal Arch and metatarsal support. It may also have an intrinsic or extrinsic posts designed to control foot motion. This device is made of a sufficiently rigid material to reduce pathological forces. HCPCS code L3020 includes additions such as postings, padded top covers, soft tissue supplements, balance padding and lesion or structure accommodations. Other additions may be required as well.
- L3030: Prescription Custom Fabricated Foot insert, each, removable. This type of device is formed directly to the patient’s foot through the use of an external heat source. The heat source should sufficiently and permanently alter the shape of the device, activating a resin, or other method by which the shape of the device is sufficiently and permanently altered in order to provide continuous contact with the unique characteristics of the plantar aspect of the patient’s foot. It may also have an intrinsic or extrinsic post designed to control foot motion. This type of orthotic is an accommodative/functional device. This device is made of sufficiently rigid material to control foot motion and or reduce pathological forces. HCPCS code L3030 includes additions such as postings, padded top covers, soft tissue supplements, balance padding and lesion or structure accommodations. Other additions may be required as well.
