L3720-Elbow orthosis, double upright with forearm/arm cuffs, free motion, custom fabricated
The following add-on codes may be used for this base code (only code for what you use). Subject to Coverage Criteria:
L3891- Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each
L3956- Addition of joint to upper extremity orthosis, any material; per joint
L3995- Addition to upper extremity orthosis, sock, fracture or equal, each
L3999- Upper limb orthosis, not otherwise specified
L3730-Elbow orthosis, double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated
The following add-on codes may be used for this base code (only code for what you use). Subject to Coverage Criteria:
L3891- Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each
L3956- Addition of joint to upper extremity orthosis, any material; per joint
L3995- Addition to upper extremity orthosis, sock, fracture or equal, each
L3999- Upper limb orthosis, not otherwise specified
L3740-Elbow orthosis, double upright with forearm/arm cuffs, adjustable position lock with active control, custom fabricated
The following add-on codes may be used for this base code (only code for what you use). Subject to Coverage Criteria:
L3891- Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each
L3956- Addition of joint to upper extremity orthosis, any material; per joint
L3995- Addition to upper extremity orthosis, sock, fracture or equal, each
L3999- Upper limb orthosis, not otherwise specified
L3763-Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
The following add-on codes may be used for this base code (only code for what you use). Subject to Coverage Criteria:
L3891- Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each
L3956- Addition of joint to upper extremity orthosis, any material; per joint
L3995- Addition to upper extremity orthosis, sock, fracture or equal, each
L3999- Upper limb orthosis, not otherwise specified
L3764-Elbow wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
The following add-on codes may be used for this base code (only code for what you use). Subject to Coverage Criteria:
L3891- Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each
L3956- Addition of joint to upper extremity orthosis, any material; per joint
L3995- Addition to upper extremity orthosis, sock, fracture or equal, each
L3999- Upper limb orthosis, not otherwise specified