HCPCS Range Additional Miscellaneous Orthotics, Upper Extremities

• 1 Hand finger orthosis (HFO), flexion glove with elastic finger control, prefabricated, off-the-shelf ( L3912 )

• 2 Hand finger orthosis (HFO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment ( L3913 )

• 3 Wrist hand orthosis (WHO), 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 ( L3915 )

• 4 Wrist hand orthosis (WHO), includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf ( L3916 )

• 5 Hand orthosis (HO), 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 ( L3917 )

• 6 Hand orthosis (HO), metacarpal fracture orthosis, prefabricated, off-the-shelf ( L3918 )

• 7 Hand orthosis (HO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment ( L3919 )

• 8 Hand finger orthosis (HFO), includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment ( L3921 )

• 9 Hand finger orthosis (HFO), 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 ( L3923 )

• 10 Hand finger orthosis (HFO), without joints, may include soft interface, straps, prefabricated, off-the-shelf ( L3924 )

• 11 Finger orthosis (FO), proximal interphalangeal (PIP)/distal interphalangeal (DIP), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf ( L3925 )

• 12 Finger orthosis (FO), 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 ( L3927 )

• 13 Hand finger orthosis (HFO), 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 ( L3929 )

• 14 Hand finger orthosis (HFO), includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, off-the-shelf ( L3930 )

• 15 Wrist hand finger orthosis (WHFO), includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, includes fitting and adjustment ( L3931 )

• 16 Finger orthosis (FO), without joints, may include soft interface, custom fabricated, includes fitting and adjustment ( L3933 )

• 17 Finger orthosis (FO), nontorsion joint, may include soft interface, custom fabricated, includes fitting and adjustment ( L3935 )

• 18 Addition of joint to upper extremity orthosis, any material; per joint ( L3956 )