Correct Coding of Finger, Hand, Hand-Finger and Wrist-Hand-Finger Braces (Orthoses) - Revised
DME MAC & PDAC Joint Publication
Based on recent analysis of claims submitted to the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) for upper extremity braces, the DME MACs and the Pricing, Data Analysis and Coding (PDAC) Contractor want to remind DMEPOS suppliers about the correct coding for these products.
The Medicare Program Integrity Manual (CMS Pub. 100-08), Chapter 3, Sections 3.3.B and 3.6.2.4 specify that for Medicare claims, only CMS and the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) have the authority to establish HCPCS Level II Coding Guidelines.
Correct HCPCS coding is a determination that the item provided to a beneficiary is billed using the appropriate HCPCS code for that item. Suppliers are required to correctly code for the item billed. An item/service is correctly coded when it meets all the coding guidelines listed in CMS HCPCS guidelines, LCDs, LCD-related Policy Articles, or DME MAC articles.
Finger Orthoses
L3925 (FINGER ORTHOSIS, PROXIMAL INTERPHALANGEAL (PIP)/DISTAL INTERPHALANGEAL (DIP), NONTORSION JOINT/SPRING, EXTENSION/FLEXION, MAY INCLUDE SOFT INTERFACE MATERIAL, PREFABRICATED, OFF-THE-SHELF) describes a dynamic prefabricated off-the-shelf (OTS) orthosis that supports the proximal interphalangeal or distal interphalangeal joint with use of a supportive non-torsion joint/spring (rubber bands, spring(s)) to control flexion and/or extension, includes soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.
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) describes a static prefabricated OTS orthosis that supports the proximal interphalangeal and distal interphalangeal joint, includes soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.
L3933 (FINGER ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT) describes a static custom fabricated orthosis that supports the proximal interphalangeal or distal interphalangeal joint, includes soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.
L3935 (FINGER ORTHOSIS, NONTORSION JOINT, MAY INCLUDE SOFT INTERFACE, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT) describes a dynamic custom fabricated orthosis that supports the proximal interphalangeal or distal interphalangeal joint with the use of a supportive non-torsion joint (rubber band, spring) to control flexion and/or extension, includes soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.
Hand Orthoses
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) describes a dynamic prefabricated custom fitted fracture orthosis that is U-shaped with a movable crossbar and pads. The brace imparts a three-point fixation on the facture but allows for free motion of wrist and fingers, includes soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.
L3918 (HAND ORTHOSIS, METACARPAL FRACTURE ORTHOSIS, PREFABRICATED, OFF-THE-SHELF) describes a dynamic prefabricated OTS fracture orthosis that is U-shaped with a movable crossbar and pads. The brace imparts a three-point fixation on the facture but allows for free motion of wrist and fingers, includes soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.
L3919 (HAND ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT) describes a static custom fabricated orthosis that supports the hand but allows for free motion of wrist and fingers, includes soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.
Hand-Finger Orthoses
L3912 (HAND FINGER ORTHOSIS (HFO), FLEXION GLOVE WITH ELASTIC FINGER CONTROL, PREFABRICATED, OFF-THE-SHELF) describes an OTS flexion glove with elastic finger control of one or more fingers and may or may not include the thumb. The fingers and/or thumb are looped with elastic bands, which fasten to the wrist. The bands can be positioned to a determined length to achieve varying degrees of flexion, includes soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.
L3913 (HAND FINGER ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT) describes a static custom fabricated orthosis with support or immobilization of the metacarpophalangeal joints, hand and fingers, includes soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.
L3921 (HAND FINGER ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINTS, ELASTIC BANDS, TURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT) describes a dynamic custom fabricated orthosis to support or immobilization of the metacarpophalangeal joints, hand and fingers with one or more supportive non-torsion joints (rubber bands, spring(s)) , includes soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.
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) describes a static prefabricated custom fitted orthosis with support or immobilization of the metacarpophalangeal joints, hand and fingers, includes soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.
L3924 (HAND FINGER ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, PREFABRICATED, OFF-THE-SHELF) describes a static prefabricated OTS orthosis with support or immobilization of the metacarpophalangeal joints, hand and fingers, includes soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.
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) describes a dynamic prefabricated custom fitted orthosis that supports the hand and fingers with use of one or more supportive non-torsion joints (rubber bands, spring(s)), includes soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.
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) describes a dynamic prefabricated OTS orthosis that supports the hand and fingers with use of one or more supportive non-torsion joints (rubber bands, spring(s)), includes soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.
Wrist-Hand Orthoses
L3905 (WRIST HAND ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINTS, ELASTIC BANDS, TURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT) describes a dynamic rigid or semi-rigid custom fabricated orthosis that supports the wrist and hand with use of one or more supportive non-torsion joints (rubber bands, spring(s)), includes soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.
L3906 (WRIST HAND ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT) describes a static rigid or semi-rigid custom fabricated orthosis with support and/or immobilization to the wrist and hand, includes soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.
L3908 (WRIST HAND ORTHOSIS, WRIST EXTENSION CONTROL COCK-UP, NONMOLDED, PREFABRICATED, OFF-THE-SHELF) describes a static prefabricated OTS orthosis with support and/or immobilization to the wrist and hand. The orthosis includes a wrist extension control cock-up feature that is adjustable to varying degrees, includes soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.
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) describes a dynamic rigid or semi-rigid prefabricated custom fitted orthosis that supports the wrist and hand with use of one or more supportive non-torsion joints (rubber bands, spring(s)) , includes soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.
L3916 (WRIST HAND ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINT(S), ELASTIC BANDS, TURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, PREFABRICATED, OFF-THE-SHELF) describes a dynamic rigid or semi-rigid prefabricated OTS orthosis that supports the wrist and hand with use of one or more supportive non-torsion joints (rubber bands, spring(s)), includes soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.
Wrist-Hand-Finger Orthoses
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) describes a dynamic custom fabricated orthosis that supports and/or immobilizes the wrist hand and finger(s) with use of one or more supportive non-torsion joints (rubber bands, spring(s)), rigid wrist component, includes soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.
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) describes a static prefabricated custom fitted orthosis with support and/or immobilization to the wrist, hand, and fingers, includes soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.
L3808 (WRIST HAND FINGER ORTHOSIS, RIGID WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE MATERIAL; STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT) describes a static rigid custom fabricated orthosis with support and/or immobilization to the wrist, hand and fingers, includes soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.
L3809 (WRIST HAND FINGER ORTHOSIS, WITHOUT JOINT(S), PREFABRICATED, OFF-THE-SHELF, ANY TYPE) describes a static prefabricated OTS orthosis with support and/or immobilization to the wrist, hand, and fingers, includes soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.
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) describes a dynamic prefabricated custom fitted orthosis that supports the wrist, hand and fingers with use of one or more supportive non-torsion joints (rubber bands, spring(s)), includes soft interface, straps and closures. This is a complete device and no add-on codes may be billed for this orthosis.
Wrist-Hand-Finger Dynamic Flexor Hinge Orthoses
L3900 (WRIST HAND FINGER ORTHOSIS, DYNAMIC FLEXOR HINGE, RECIPROCAL WRIST EXTENSION/ FLEXION, FINGER FLEXION/EXTENSION, WRIST OR FINGER DRIVEN, CUSTOM FABRICATED) describes a custom fabricated orthosis to provide a functional three-jaw-chuck digit grasp pattern. Product uses linked joints, wrist and metacarpophalangeal joint, and rigid digit components. Extension of wrist causes reciprocal flexion at metacarpophalangeal joint with resulting three jaw-chuck digit grip. Included in the code are closures from lacing, webbing, hook and loop, or equal, and additional support strapping. This is a complete device and no add-on codes may be billed for this orthosis.
L3901 (WRIST HAND FINGER ORTHOSIS, DYNAMIC FLEXOR HINGE, RECIPROCAL WRIST EXTENSION/ FLEXION, FINGER FLEXION/EXTENSION, CABLE DRIVEN, CUSTOM FABRICATED) describes a custom fabricated orthosis to provide a functional three-jaw-chuck digit grasp pattern. Product uses linked joints, wrist and metacarpophalangeal joint, and rigid digit components. Extension of wrist causes reciprocal flexion at metacarpophalangeal joint with resulting three jaw-chuck digit grip. Wrist extension is assisted by a body powered cable system anchored to the contralateral shoulder with an axillary loop harness. Included in the code are closures from lacing, webbing, hook and loop, or equal, and additional support strapping. This is a complete device and no add-on codes may be billed for this orthosis.
Correct coding is an essential element for correct claim payment. The Pricing, Data Analysis and Coding (PDAC) contractor maintains a variety of resources to assist suppliers in determining the appropriate code for Medicare billing. For questions about correct coding, contact the PDAC HCPCS Helpline at (877) 735-1326 during the hours of 9:30 am to 5:00 pm ET, Monday through Friday. You may also visit the PDAC website to chat with a representative, or select the Contact Us button at the top of the PDAC website for email, FAX, or postal mail information.
| Date | Update |
|---|---|
| 11/02/2021 | Published on PDAC website |
| 11/24/2021 | Revised to include HCPCS codes L3806 and L3807 under the Wrist-Hand-Finger Orthoses section |