HCPCS Range Orthotic Replacement Parts or Repair

• 1 Replace girdle for spinal orthosis (Cervical-thoracic-lumbar-sacral orthosis (CTLSO) or Shoulder orthosis (SO)) ( L4000 )

• 2 Replacement strap, any orthosis, includes all components, any length, any type ( L4002 )

• 3 Replace trilateral socket brim ( L4010 )

• 4 Replace quadrilateral socket brim, molded to patient model ( L4020 )

• 5 Replace quadrilateral socket brim, custom fitted ( L4030 )

• 6 Replace molded thigh lacer, for custom fabricated orthosis only ( L4040 )

• 7 Replace non-molded thigh lacer, for custom fabricated orthosis only ( L4045 )

• 8 Replace molded calf lacer, for custom fabricated orthosis only ( L4050 )

• 9 Replace non-molded calf lacer, for custom fabricated orthosis only ( L4055 )

• 10 Replace high roll cuff ( L4060 )

• 11 Replace proximal and distal upright for KAFO ( L4070 )

• 12 Replace metal bands KAFO, proximal thigh ( L4080 )

• 13 Replace metal bands KAFO-AFO, calf or distal thigh ( L4090 )

• 14 Replace leather cuff KAFO, proximal thigh ( L4100 )

• 15 Replace leather cuff KAFO-AFO, calf or distal thigh ( L4110 )

• 16 Replace pretibial shell ( L4130 )

• 17 Repair of orthotic device, labor component, per 15 minutes ( L4205 )

• 18 Repair of orthotic device, repair or replace minor parts ( L4210 )