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HCPCS Procedure & Supply Codes →
Orthotic Devices & Services →
section notes
Orthopedic Shoes →
section notes
Orthopedic Footwear →
section notes
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 (...
L3225   Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (or...
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
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