HCPCS Range Other Orthopedic Footwear

• 1 Orthopedic footwear, ladies shoe, Oxford, each ( L3215 )

• 2 Orthopedic footwear, ladies shoe, depth inlay, each ( L3216 )

• 3 Orthopedic footwear, ladies shoe, hightop, depth inlay, each ( L3217 )

• 4 Orthopedic footwear, mens shoe, Oxford, each ( L3219 )

• 5 Orthopedic footwear, mens shoe, depth inlay, each ( L3221 )

• 6 Orthopedic footwear, mens shoe, hightop, depth inlay, each ( L3222 )

• 7 Orthopedic footwear, custom shoe, depth inlay, each ( L3230 )

• 8 Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each ( L3250 )

• 9 Foot, shoe molded to patient model, silicone shoe, each ( L3251 )

• 10 Foot, shoe molded to patient model, Plastazote (or similar), custom fabricated, each ( L3252 )

• 11 Foot, molded shoe Plastazote (or similar) custom fitted, each ( L3253 )

• 12 Non-standard size or width ( L3254 )

• 13 Non-standard size or length ( L3255 )

• 14 Orthopedic footwear, additional charge for split size ( L3257 )

• 15 Surgical boot/shoe, each ( L3260 )

• 16 Plastazote sandal, each ( L3265 )

• 17 Orthopedic footwear, woman's shoe, Oxford, used as an integral part of a brace (orthosis) ( L3224 )

• 18 Orthopedic footwear, man's shoe, Oxford, used as an integral part of a brace (orthosis) ( L3225 )