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					                                      HCPCS L CODES                                                                                                          Last Updated Decebmber 2011



        Action                                                                                                                                 Code Add   Action Eff
HCPCS            Long Description                                                                                                   Coverage                              Term Date
        Code                                                                                                                                     Date       Date

L0100     D      CRANIAL ORTHOSIS (HELMET), WITH OR WITHOUT SOFT INTERFACE, MOLDED TO PATIENT MODEL                                    C       19820101    20070101        20061231


L0110     D      CRANIAL ORTHOSIS (HELMET), WITH OR WITHOUT SOFT-INTERFACE, NON-MOLDED                                                 C       19820101    20070101        20061231


                 CRANIAL CERVICAL ORTHOSIS, CONGENITAL TORTICOLLIS TYPE, WITH OR WITHOUT SOFT NTERFACE
L0112                                                                                                                                  C       20040101    20040101
                 MATERIAL, ADJUSTABLE RANGE OF MOTION JOINT, CUSTOM FABRICATED

                 CRANIAL CERVICAL ORTHOSIS, TORTICOLLIS TYPE, WITH OR WITHOUT JOINT, WITH OR WITHOUT SOFT
L0113     A                                                                                                                            C       20090101    20090101
                 INTERFACE MATERIAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT


L0120            CERVICAL, FLEXIBLE, NON-ADJUSTABLE (FOAM COLLAR)                                                                      C       19820101    19960101


L0130            CERVICAL, FLEXIBLE, THERMOPLASTIC COLLAR, MOLDED TO PATIENT                                                           C       19840101    19960101


L0140            CERVICAL, SEMI-RIGID, ADJUSTABLE (PLASTIC COLLAR)                                                                     C       19820101    19960101


                 CERVICAL, SEMI-RIGID, ADJUSTABLE MOLDED CHIN CUP (PLASTIC COLLAR WITH MANDIBULAR/OCCIPITAL
L0150                                                                                                                                  C       19820101    19960101
                 PIECE)


L0160            CERVICAL, SEMI-RIGID, WIRE FRAME OCCIPITAL/MANDIBULAR SUPPORT                                                         C       19820101    19960101


L0170            CERVICAL, COLLAR, MOLDED TO PATIENT MODEL                                                                             C       19860101    19960101


L0172            CERVICAL, COLLAR, SEMI-RIGID THERMOPLASTIC FOAM, TWO PIECE                                                            C       19880101    19960101


L0174            CERVICAL, COLLAR, SEMI-RIGID, THERMOPLASTIC FOAM, TWO PIECE WITH THORACIC EXTENSION                                   C       19880101    19960101


L0180            CERVICAL, MULTIPLE POST COLLAR, OCCIPITAL/MANDIBULAR SUPPORTS, ADJUSTABLE                                             C       19840101    19960101


                 CERVICAL, MULTIPLE POST COLLAR, OCCIPITAL/MANDIBULAR SUPPORTS, ADJUSTABLE CERVICAL BARS (SOMI,
L0190                                                                                                                                  C       19820101    19960101
                 GUILFORD, TAYLOR TYPES)

                 CERVICAL, MULTIPLE POST COLLAR, OCCIPITAL/MANDIBULAR SUPPORTS, ADJUSTABLE CERVICAL BARS, AND
L0200                                                                                                                                  C       19840101    19960101
                 THORACIC EXTENSION


L0210     D      THORACIC, RIB BELT                                                                                                    C       19820101    19960101        20091231


L0220            THORACIC, RIB BELT, CUSTOM FABRICATED                                                                                 C       19820101    19960101



                                                         Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                               Code Add   Action Eff
HCPCS            Long Description                                                                                                 Coverage                           Term Date
        Code                                                                                                                                   Date       Date

                 SPINAL ORTHOSIS, ANTERIOR-POSTERIOR-LATERAL CONTROL, WITH INTERFACE MATERIAL, CUSTOM FITTED
L0430                                                                                                                                C       19880101    20050101
                 (DEWALL POSTURE PROTECTOR ONLY)

                 TLSO, FLEXIBLE, PROVIDES TRUNK SUPPORT, UPPER THORACIC REGION, PRODUCES INTRACAVITARY
L0450            PRESSURE TO REDUCE LOAD ON THE INTEVERTEBRAL DISKS WITH RIGID STAYS OR PANEL(S), INCLUDES                           C       20030101    20030101
                 SHOULDER STRAPS AND CLOSURES, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 TLSO, FLEXIBLE, PROVIDES TRUNK SUPPORT, UPPER THORACIC REGION, PRODUCES INTRACAVITARY
L0452            PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISKS WITH RIGID STAYS OR PANEL(S), INCLUDES                          C       20030101    20030101
                 SHOULDER STRAPS AND CLOSURES, CUSTOM FABRICATED

                 TLSO FLEXIBLE, PROVIDES TRUNK SUPPORT, EXTENDS FROM SACROCOCCYGEAL JUNCTION TO ABOVE T-9
                 VERTEBRA, RESTRICTS GROSS TRUNK MOTION IN THE SAGITTAL PLANE, PRODUCES INTRACAVITARY
L0454                                                                                                                                C       20030101    20030101
                 PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISKS WITH RIGID STAYS OR PANEL(S), INCLUDES
                 SHOULDER STRAPS AND CLOSURES, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 TLSO, FLEXIBLE, PROVIDES TRUNK SUPPORT, THORACIC REGION, RIGID POSTERIOR PANEL AND SOFT
                 ANTERIOR APRON, EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND TERMINATES JUST INFERIOR TO
L0456            THE SCAPULAR SPINE, RESTRICTS GROSS TRUNK MOTION IN THE SAGITTAL PLANE, PRODUCES                                    C       20030101    20030101
                 INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISKS, INCLUDES STRAPS AND
                 CLOSURES, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 TLSO, TRIPLANAR CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, TWO RIGID PLASTIC SHELLS,
                 POSTERIOR EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND TERMINATES JUST INFERIOR TO THE
                 SCAPULAR SPINE, ANTERIOR EXTENDS FROM THE SYMPHYSIS PUBIS TO THE XIPHOID, SOFT LINER, RESTRICTS
L0458                                                                                                                                C       20030101    20030101
                 GROSS TRUNK MOTION IN THE SAGITTAL, CORONAL, AND TRANSVERSE PLANES, LATERAL STRENGTH IS
                 PROVIDED BY OVERLAPPING PLASTIC AND STABILIZING CLOSURES, INCLUDES STRAPS AND CLOSURES,
                 PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 TLSO, TRIPLANAR CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, TWO RIGID PLASTIC SHELLS,
                 POSTERIOR EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND TERMINATES JUST INFERIOR TO THE
                 SCAPULAR SPINE, ANTERIOR EXTENDS FROM THE SYMPHYSIS PUBIS TO THE STERNAL NOTCH, SOFT LINER,
L0460                                                                                                                                C       20030101    20030101
                 RESTRICTS GROSS TRUNK MOTION IN THE SAGITTAL, CORONAL, AND TRANSVERSE PLANES, LATERAL
                 STRENGTH IS PROVIDED BY OVERLAPPING PLASTIC AND STABILIZING CLOSURES, INCLUDES STRAPS AND
                 CLOSURES, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 TLSO, TRIPLANAR CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, THREE RIGID PLASTIC SHELLS,
                 POSTERIOR EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND TERMINATES JUST INFERIOR TO THE
                 SCAPULAR SPINE, ANTERIOR EXTENDS FROM THE SYMPHYSIS PUBIS TO THE STERNAL NOTCH, SOFT LINER,
L0462                                                                                                                                C       20030101    20030101
                 RESTRICTS GROSS TRUNK MOTION IN THE SAGITTAL, CORONAL, AND TRANSVERSE PLANES, LATERAL
                 STRENGTH IS PROVIDED BY OVERLAPPING PLASTIC AND STABILIZING CLOSURES, INCLUDES STRAPS AND
                 CLOSURES, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 TLSO, TRIPLANAR CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, FOUR RIGID PLASTIC SHELLS,
                 POSTERIOR EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND TERMINATES JUST INFERIOR TO THE
                 SCAPULAR SPINE, ANTERIOR EXTENDS FROM THE SYMPHYSIS PUBIS TO THE STERNAL NOTCH, SOFT LINER,
L0464                                                                                                                                C       20030101    20030101
                 RESTRICTS GROSS TRUNK MOTION IN THE SAGITTAL, CORONAL, AND TRANSVERSE PLANES, LATERAL
                 STRENGTH IS PROVIDED BY OVERLAPPING PLASTIC AND STABILIZING CLOSURES, INCLUDES STRAPS AND
                 CLOSURES, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 TLSO, SAGITTAL CONTROL, RIGID POSTERIOR FRAME AND FLEXIBLE SOFT ANTERIOR APRON WITH STRAPS,
                 CLOSURES AND PADDING, RESTRICTS GROSS TRUNK MOTION IN SAGITTAL PLANE, PRODUCES
L0466                                                                                                                                C       20030101    20030101
                 INTRACAVITARY PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISKS, INCLUDES FITTING AND SHAPING
                 THE FRAME, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT



                                                       Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date

                 TLSO, SAGITTAL-CORONAL CONTROL, RIGID POSTERIOR FRAME AND FLEXIBLE SOFT ANTERIOR APRON WITH
                 STRAPS, CLOSURES AND PADDING, EXTENDS FROM SACROCOCCYGEAL JUNCTION OVER SCAPULAE, LATERAL
                 STRENGTH PROVIDED BY PELVIC, THORACIC, AND LATERAL FRAME PIECES, RESTRICTS GROSS TRUNK
L0468                                                                                                                                 C       20030101    20030101
                 MOTION IN SAGITTAL AND CORONAL PLANES, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON
                 INTERVERTEBRAL DISKS, INCLUDES FITTING AND SHAPING THE FRAME, PREFABRICATED, INCLUDES FITTING
                 AND ADJUSTMENT

                 TLSO, TRIPLANAR CONTROL, RIGID POSTERIOR FRAME AND FLEXIBLE SOFT ANTERIOR APRON WITH STRAPS,
                 CLOSURES AND PADDING, EXTENDS FROM SACROCOCCYGEAL JUNCTION TO SCAPULA, LATERAL STRENGTH
                 PROVIDED BY PELVIC, THORACIC, AND LATERAL FRAME PIECES, ROTATIONAL STRENGTH PROVIDED BY
L0470                                                                                                                                 C       20030101    20030101
                 SUBCLAVICULAR EXTENSIONS, RESTRICTS GROSS TRUNK MOTION IN SAGITTAL, CORONAL AND TRANSVERSE
                 PLANES, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISKS,
                 INCLUDES FITTING AND SHAPING THE FRAME, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 TLSO, TRIPLANAR CONTROL, HYPEREXTENSION, RIGID ANTERIOR AND LATERAL FRAME EXTENDS FROM
                 SYMPHYSIS PUBIS TO STERNAL NOTCH WITH TWO ANTERIOR COMPONENTS (ONE PUBIC AND ONE STERNAL),
L0472            POSTERIOR AND LATERAL PADS WITH STRAPS AND CLOSURES, LIMITS SPINAL FLEXION, RESTRICTS GROSS                          C       20030101    20030101
                 TRUNK MOTION IN SAGITTAL, CORONAL, AND TRANSVERSE PLANES, INCLUDES FITTING AND SHAPING THE
                 FRAME, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 TLSO, SAGITTAL-CORONAL CONTROL, FLEXION COMPRESSION JACKET, TWO RIGID PLASTIC SHELLS WITH
                 SOFT LINER, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION AND TERMINATES AT OR BEFORE THE
                 T-9 VERTEBRA, ANTERIOR EXTENDS FROM SYMPHYSIS PUBIS TO XIPHOID, USUALLY LACED TOGETHER ON
L0476     D                                                                                                                           C       20030101    20050101     20041231
                 ONE SIDE, RESTRICTS GROSS TRUNK MOTION IN SAGITTAL AND CORONAL PLANES, ALLOWS FREE FLEXION
                 AND COMPRESSION OF LS REGION, INCLUDES STRAPS AND CLOSURES, PREFABRICATED, INCLUDES FITTING
                 AND ADJUSTMENT

                 TLSO, SAGITTAL-CORONAL CONTROL, FLEXION COMPRESSION JACKET, TWO RIGID PLASTIC SHELLS WITH
                 SOFT LINER, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION AND TERMINATES AT OR BEFORE THE
L0478     D      T-9 VERTEBRA, ANTERIOR EXTENDS FROM SYMPHYSIS PUBIS TO XIPHOID, USUALLY LACED TOGETHER ON                            C       20030101    20050101     20041231
                 ONE SIDE, RESTRICTS GROSS TRUNK MOTION IN SAGITTAL AND CORONAL PLANES, ALLOWS FREE FLEXION
                 AND COMPRESSION OF LS REGION, INCLUDES STRAPS AND CLOSURES, CUSTOM FABRICATED

                 TLSO, TRIPLANAR CONTROL, ONE PIECE RIGID PLASTIC SHELL WITHOUT INTERFACE LINER, WITH MULTIPLE
                 STRAPS AND CLOSURES, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION AND TERMINATES JUST
L0480            INFERIOR TO SCAPULAR SPINE, ANTERIOR EXTENDS FROM SYMPHYSIS PUBIS TO STERNAL NOTCH, ANTERIOR                         C       20030101    20040101
                 OR POSTERIOR OPENING, RESTRICTS GROSS TRUNK MOTION IN SAGITTAL, CORONAL, AND TRANSVERSE
                 PLANES, INCLUDES A CARVED PLASTER OR CAD-CAM MODEL, CUSTOM FABRICATED

                 TLSO, TRIPLANAR CONTROL, ONE PIECE RIGID PLASTIC SHELL WITH INTERFACE LINER, MULTIPLE STRAPS AND
                 CLOSURES, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION AND TERMINATES JUST INFERIOR TO
L0482            SCAPULAR SPINE, ANTERIOR EXTENDS FROM SYMPHYSIS PUBIS TO STERNAL NOTCH, ANTERIOR OR                                  C       20030101    20030101
                 POSTERIOR OPENING, RESTRICTS GROSS TRUNK MOTION IN SAGITTAL, CORONAL, AND TRANSVERSE PLANES,
                 INCLUDES A CARVED PLASTER OR CAD-CAM MODEL, CUSTOM FABRICATED

                 TLSO, TRIPLANAR CONTROL, TWO PIECE RIGID PLASTIC SHELL WITHOUT INTERFACE LINER, WITH MULTIPLE
                 STRAPS AND CLOSURES, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION AND TERMINATES JUST
                 INFERIOR TO SCAPULAR SPINE, ANTERIOR EXTENDS FROM SYMPHYSIS PUBIS TO STERNAL NOTCH, LATERAL
L0484                                                                                                                                 C       20030101    20030101
                 STRENGTH IS ENHANCED BY OVERLAPPING PLASTIC, RESTRICTS GROSS TRUNK MOTION IN SAGITTAL,
                 CORONAL, AND TRANSVERSE PLANES, INCLUDES A CARVED PLASTER OR CAD-CAM MODEL, CUSTOM
                 FABRICATED




                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date

                 TLSO, TRIPLANAR CONTROL, TWO PIECE RIGID PLASTIC SHELL WITH INTERFACE LINER, MULTIPLE STRAPS
                 AND CLOSURES, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION AND TERMINATES JUST INFERIOR
L0486            TO SCAPULAR SPINE, ANTERIOR EXTENDS FROM SYMPHYSIS PUBIS TO STERNAL NOTCH, LATERAL STRENGTH                          C       20030101    20030101
                 IS ENHANCED BY OVERLAPPING PLASTIC, RESTRICTS GROSS TRUNK MOTION IN SAGITTAL, CORONAL, AND
                 TRANSVERSE PLANES, INCLUDES A CARVED PLASTER OR CAD-CAM MODEL, CUSTOM FABRICATED

                 TLSO, TRIPLANAR CONTROL, ONE PIECE RIGID PLASTIC SHELL WITH INTERFACE LINER, MULTIPLE STRAPS AND
                 CLOSURES, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION AND TERMINATES JUST INFERIOR TO
L0488            SCAPULAR SPINE, ANTERIOR EXTENDS FROM SYMPHYSIS PUBIS TO STERNAL NOTCH, ANTERIOR OR                                  C       20030101    20030101
                 POSTERIOR OPENING, RESTRICTS GROSS TRUNK MOTION IN SAGITTAL, CORONAL, AND TRANSVERSE PLANES,
                 PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 TLSO, SAGITTAL-CORONAL CONTROL, ONE PIECE RIGID PLASTIC SHELL, WITH OVERLAPPING REINFORCED
                 ANTERIOR, WITH MULTIPLE STRAPS AND CLOSURES, POSTERIOR EXTENDS FROM SACROCOCCYGEAL
L0490            JUNCTION AND TERMINATES AT OR BEFORE THE T-9 VERTEBRA, ANTERIOR EXTENDS FROM SYMPHYSIS PUBIS                         C       20030101    20030101
                 TO XIPHOID, ANTERIOR OPENING, RESTRICTS GROSS TRUNK MOTION IN SAGITTAL AND CORONAL PLANES,
                 PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 TLSO, SAGITTAL-CORONAL CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, TWO RIGID PLASTIC SHELLS,
                 POSTERIOR EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND TERMINATES JUST INFERIOR TO THE
                 SCAPULAR SPINE, ANTERIOR EXTENDS FROM THE SYMPHYSIS PUBIS TO THE XIPHOID, SOFT LINER, RESTRICTS
L0491                                                                                                                                 C       20060101    20060101
                 GROSS TRUNK MOTION IN THE SAGITTAL AND CORONAL PLANES, LATERAL STRENGTH IS PROVIDED BY
                 OVERLAPPING PLASTIC AND STABILIZING CLOSURES, INCLUDES STRAPS AND CLOSURES, PREFABRICATED,
                 INCLUDES FITTING AND ADJUSTMENT

                 TLSO, SAGITTAL-CORONAL CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, THREE RIGID PLASTIC SHELLS,
                 POSTERIOR EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND TERMINATES JUST INFERIOR TO THE
                 SCAPULAR SPINE, ANTERIOR EXTENDS FROM THE SYMPHYSIS PUBIS TO THE XIPHOID, SOFT LINER, RESTRICTS
L0492                                                                                                                                 C       20060101    20060101
                 GROSS TRUNK MOTION IN THE SAGITTAL AND CORONAL PLANES, LATERAL STRENGTH IS PROVIDED BY
                 OVERLAPPING PLASTIC AND STABILIZING CLOSURES, INCLUDES STRAPS AND CLOSURES, PREFABRICATED,
                 INCLUDES FITTING AND ADJUSTMENT


L0500     D      LUMBAR-SACRAL-ORTHOSIS (LSO), FLEXIBLE, (LUMBO-SACRAL SUPPORT)                                                       C       19860101    20050101     20041231


L0510     D      LSO, FLEXIBLE (LUMBO-SACRAL SUPPORT), CUSTOM FABRICATED                                                              C       19820101    20050101     20041231


L0515     D      LSO, ANTERIOR-POSTERIOR CONTROL, WITH RIGID OR SEMI-RIGID POSTERIOR PANEL, PREFABRICATED                             C       19880101    20050101     20041231


L0520     D      LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL (KNIGHT, WILCOX TYPES), WITH APRON FRONT                                     C       19850101    20050101     20041231


L0530     D      LSO, ANTERIOR-POSTERIOR CONTROL (MACAUSLAND TYPE), WITH APRON FRONT                                                  C       19840101    20050101     20041231


L0540     D      LSO, LUMBAR FLEXION (WILLIAMS FLEXION TYPE)                                                                          C       19850101    20050101     20041231


L0550     D      LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, MOLDED TO PATIENT MODEL                                                     C       19840101    20050101     20041231




                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date


L0560     D      LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, MOLDED TO PATIENT MODEL, WITH INTERFACE MATERIAL                            C       19860101    20050101     20041231


                 LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, WITH RIGID OR SEMI-RIGID POSTERIOR PANEL,
L0561     D                                                                                                                           C       20020101    20050101     20041231
                 PREFABRICATED


L0565     D      LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, CUSTOM FITTED                                                               C       19880101    20050101     20041231


L0600     D      SACROILIAC, FLEXIBLE (SACROILIAC SURGICAL SUPPORT),                                                                  C       19820101    20050101     20041231


L0610     D      SACROILIAC, FLEXIBLE (SACROILIAC SURGICAL SUPPORT), CUSTOM FABRICATED                                                C       19820101    20050101     20041231


L0620     D      SACROILIAC, SEMI-RIGID (GOLDTHWAITE, OSGOOD TYPES), WITH APRON FRONT                                                 C       19820101    20050101     20041231


                 SACROILIAC ORTHOSIS, FLEXIBLE, PROVIDES PELVIC-SACRAL SUPPORT, REDUCES MOTION ABOUT THE
L0621            SACROILIAC JOINT, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN DESIGN,                                   C       20060101    20060101
                 PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 SACROILIAC ORTHOSIS, FLEXIBLE, PROVIDES PELVIC-SACRAL SUPPORT, REDUCES MOTION ABOUT THE
L0622            SACROILIAC JOINT, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN DESIGN, CUSTOM                            C       20060101    20060101
                 FABRICATED

                 SACROILIAC ORTHOSIS, PROVIDES PELVIC-SACRAL SUPPORT, WITH RIGID OR SEMI-RIGID PANELS OVER THE
L0623            SACRUM AND ABDOMEN, REDUCES MOTION ABOUT THE SACROILIAC JOINT, INCLUDES STRAPS, CLOSURES,                            C       20060101    20060101
                 MAY INCLUDE PENDULOUS ABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 SACROILIAC ORTHOSIS, PROVIDES PELVIC-SACRAL SUPPORT, WITH RIGID OR SEMI-RIGID PANELS PLACED
L0624            OVER THE SACRUM AND ABDOMEN, REDUCES MOTION ABOUT THE SACROILIAC JOINT, INCLUDES STRAPS,                             C       20060101    20060101
                 CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN DESIGN, CUSTOM FABRICATED

                 LUMBAR ORTHOSIS, FLEXIBLE, PROVIDES LUMBAR SUPPORT, POSTERIOR EXTENDS FROM L-1 TO BELOW L-5
                 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS,
L0625                                                                                                                                 C       20060101    20060101
                 INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN DESIGN, SHOULDER STRAPS, STAYS,
                 PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 LUMBAR ORTHOSIS, SAGITTAL CONTROL, WITH RIGID POSTERIOR PANEL(S), POSTERIOR EXTENDS FROM L1 TO
                 BELOW L-5 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL
L0626                                                                                                                                 C       20060101    20060101
                 DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PADDING, STAYS, SHOULDER STRAPS, PENDULOUS
                 ABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 LUMBAR ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR PANELS, POSTERIOR
                 EXTENDS FROM L1 TO BELOW L-5 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON
L0627                                                                                                                                 C       20060101    20060101
                 THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PADDING, SHOULDER STRAPS,
                 PENDULOUS ABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 LUMBAR-SACRAL ORTHOSIS, FLEXIBLE, PROVIDES LUMBO-SACRAL SUPPORT, POSTERIOR EXTENDS FROM
                 SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD
L0628                                                                                                                                 C       20060101    20060101
                 ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE STAYS, SHOULDER STRAPS,
                 PENDULOUS ABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT




                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                              Code Add   Action Eff
HCPCS            Long Description                                                                                                Coverage                           Term Date
        Code                                                                                                                                  Date       Date

                 LUMBAR-SACRAL ORTHOSIS, FLEXIBLE, PROVIDES LUMBO-SACRAL SUPPORT, POSTERIOR EXTENDS FROM
                 SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD
L0629                                                                                                                               C       20060101    20060101
                 ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE STAYS, SHOULDER STRAPS,
                 PENDULOUS ABDOMEN DESIGN, CUSTOM FABRICATED

                 LUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID POSTERIOR PANEL(S), POSTERIOR EXTENDS
                 FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE
L0630                                                                                                                               C       20060101    20060101
                 LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PADDING, STAYS,
                 SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 LUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR PANELS,
                 POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY
L0631     C      PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE                        C       20060101    20070101     20070101
                 PADDING, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING AND
                 ADJUSTMENT

                 LUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR PANELS,
                 POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY
L0632                                                                                                                               C       20060101    20060101
                 PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE
                 PADDING, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, CUSTOM FABRICATED

                 LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID POSTERIOR FRAME/PANEL(S),
                 POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL STRENGTH PROVIDED
L0633            BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON                                   C       20060101    20060101
                 INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PADDING, STAYS, SHOULDER STRAPS,
                 PENDULOUS ABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID POSTERIOR FRAME/PANEL(S),
                 POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL STRENGTH PROVIDED
L0634            BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON                                   C       20060101    20060101
                 INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PADDING, STAYS, SHOULDER STRAPS,
                 PENDULOUS ABDOMEN DESIGN, CUSTOM FABRICATED

                 LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, LUMBAR FLEXION, RIGID POSTERIOR
                 FRAME/PANELS, LATERAL ARTICULATING DESIGN TO FLEX THE LUMBAR SPINE, POSTERIOR EXTENDS FROM
                 SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERAL
L0635                                                                                                                               C       20060101    20060101
                 FRAME/PANELS, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS,
                 INCLUDES STRAPS, CLOSURES, MAY INCLUDE PADDING, ANTERIOR PANEL, PENDULOUS ABDOMEN DESIGN,
                 PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 LUMBAR SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, LUMBAR FLEXION, RIGID POSTERIOR
                 FRAME/PANELS, LATERAL ARTICULATING DESIGN TO FLEX THE LUMBAR SPINE, POSTERIOR EXTENDS FROM
                 SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERAL
L0636                                                                                                                               C       20060101    20060101
                 FRAME/PANELS, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS,
                 INCLUDES STRAPS, CLOSURES, MAY INCLUDE PADDING, ANTERIOR PANEL, PENDULOUS ABDOMEN DESIGN,
                 CUSTOM FABRICATED

                 LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR
                 FRAME/PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL
L0637            STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY PRESSURE TO REDUCE                         C       20060101    20060101
                 LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PADDING, SHOULDER
                 STRAPS, PENDULOUS ABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT




                                                      Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                               Code Add   Action Eff
HCPCS            Long Description                                                                                                 Coverage                           Term Date
        Code                                                                                                                                   Date       Date

                 LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR
                 FRAME/PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL
L0638            STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY PRESSURE TO REDUCE                          C       20060101    20060101
                 LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PADDING, SHOULDER
                 STRAPS, PENDULOUS ABDOMEN DESIGN, CUSTOM FABRICATED

                 LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, RIGID SHELL(S)/PANEL(S), POSTERIOR EXTENDS
                 FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, ANTERIOR EXTENDS FROM SYMPHYSIS PUBIS TO
                 XYPHOID, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS,
L0639                                                                                                                                C       20060101    20060101
                 OVERALL STRENGTH IS PROVIDED BY OVERLAPPING RIGID MATERIAL AND STABILIZING CLOSURES, INCLUDES
                 STRAPS, CLOSURES, MAY INCLUDE SOFT INTERFACE, PENDULOUS ABDOMEN DESIGN, PREFABRICATED,
                 INCLUDES FITTING AND ADJUSTMENT

                 LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, RIGID SHELL(S)/PANEL(S), POSTERIOR EXTENDS
                 FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, ANTERIOR EXTENDS FROM SYMPHYSIS PUBIS TO
L0640            XIPHOID, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS,                                C       20060101    20060101
                 OVERALL STRENGTH IS PROVIDED BY OVERLAPPING RIGID MATERIAL AND STABILIZING CLOSURES, INCLUDES
                 STRAPS, CLOSURES, MAY INCLUDE SOFT INTERFACE, PENDULOUS ABDOMEN DESIGN, CUSTOM FABRICATED


L0700            CERVICAL-THORACIC-LUMBAR-SACRAL-ORTHOSES (CTLSO), ANTERIOR-POSTERIOR-LATERAL                                        C       19840101    19960101


L0700            CONTROL, MOLDED TO PATIENT MODEL, (MINERVA TYPE)


L0710            CTLSO, ANTERIOR-POSTERIOR-LATERAL-CONTROL, MOLDED TO PATIENT MODEL, WITH                                            C       19840101    19960101


L0710            INTERFACE MATERIAL, (MINERVA TYPE)


L0810            HALO PROCEDURE, CERVICAL HALO INCORPORATED INTO JACKET VEST                                                         C       19860101    19960101


L0820            HALO PROCEDURE, CERVICAL HALO INCORPORATED INTO PLASTER BODY JACKET                                                 C       19860101    19960101


L0830            HALO PROCEDURE, CERVICAL HALO INCORPORATED INTO MILWAUKEE TYPE ORTHOSIS                                             C       19860101    19960101


                 ADDITION TO HALO PROCEDURE, MAGNETIC RESONANCE IMAGE COMPATIBLE SYSTEMS, RINGS AND PINS, ANY
L0859                                                                                                                                C       20060101    20060101
                 MATERIAL


L0860     D      ADDITION TO HALO PROCEDURES, MAGNETIC REASONANCE IMAGE COMPATIBLE SYSTEM                                            C       19890101    20060101     20051231


L0861            ADDITION TO HALO PROCEDURE, REPLACEMENT LINER/INTERFACE MATERIAL                                                    C       20040101    20040101


L0960     D      TORSO SUPPORT, POST SURGICAL SUPPORT, PADS FOR POST SURGICAL SUPPORT                                                C       19860101    20080101     20071231


L0970            TLSO, CORSET FRONT                                                                                                  C       19820101    19960101



                                                       Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                               Code Add   Action Eff
HCPCS            Long Description                                                                                                 Coverage                           Term Date
        Code                                                                                                                                   Date       Date


L0972            LSO, CORSET FRONT                                                                                                   C       19820101    19960101


L0974            TLSO, FULL CORSET                                                                                                   C       19820101    19960101


L0976            LSO, FULL CORSET                                                                                                    C       19820101    19960101


L0978            AXILLARY CRUTCH EXTENSION                                                                                           C       19820101    19960101


L0980            PERONEAL STRAPS, PAIR                                                                                               C       19860101    19960101


L0982            STOCKING SUPPORTER GRIPS, SET OF FOUR (4)                                                                           C       19820101    19960101


L0984            PROTECTIVE BODY SOCK, EACH                                                                                          C       19940101    19960101


L0999            ADDITION TO SPINAL ORTHOSIS, NOT OTHERWISE SPECIFIED                                                                C       19980101    19980101


                 CERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO) (MILWAUKEE), INCLUSIVE OF FURNISHING INITIAL
L1000                                                                                                                                C       19860101    19960101
                 ORTHOSIS, INCLUDING MODEL

                 CERVICAL THORACIC LUMBAR SACRAL ORTHOSIS, IMMOBILIZER, INFANT SIZE, PREFABRICATED, INCLUDES
L1001     A                                                                                                                          C       20070101    20070101
                 FITTING AND ADJUSTMENT


L1005            TENSION BASED SCOLIOSIS ORTHOSIS AND ACCESSORY PADS, INCLUDES FITTING AND ADJUSTMENT                                C       20020101    20020101


                 ADDITION TO CERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO) OR SCOLIOSIS ORTHOSIS, AXILLA
L1010                                                                                                                                C       19860101    19960101
                 SLING


L1020            ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, KYPHOSIS PAD                                                               C       19860101    19960101


L1025            ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, KYPHOSIS PAD, FLOATING                                                     C       19880101    19960101


L1030            ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, LUMBAR BOLSTER PAD                                                         C       19860101    19960101


L1040            ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, LUMBAR OR LUMBAR RIB PAD                                                   C       19860101    19960101


L1050            ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, STERNAL PAD                                                                C       19860101    19960101


L1060            ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, THORACIC PAD                                                               C       19860101    19960101




                                                       Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                 Code Add   Action Eff
HCPCS            Long Description                                                                                                   Coverage                           Term Date
        Code                                                                                                                                     Date       Date


L1070            ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, TRAPEZIUS SLING                                                              C       19860101    19960101


L1080            ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, OUTRIGGER                                                                    C       19860101    19960101


L1085            ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, OUTRIGGER, BILATERAL WITH VERTICAL EXTENSIONS                                C       19880101    19960101


L1090            ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, LUMBAR SLING                                                                 C       19860101    19960101


L1100            ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, RING FLANGE, PLASTIC OR LEATHER                                              C       19860101    19960101


                 ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, RING FLANGE, PLASTIC OR LEATHER, MOLDED TO PATIENT
L1110                                                                                                                                  C       19860101    19960101
                 MODEL


L1120            ADDITION TO CTLSO, SCOLIOSIS ORTHOSIS, COVER FOR UPRIGHT, EACH                                                        C       19860101    19960101


L1200            THORACIC-LUMBAR-SACRAL-ORTHOSIS (TLSO), INCLUSIVE OF FURNISHING INITIAL ORTHOSIS ONLY                                 C       19860101    19960101


L1210            ADDITION TO TLSO, (LOW PROFILE), LATERAL THORACIC EXTENSION                                                           C       19860101    19960101


L1220            ADDITION TO TLSO, (LOW PROFILE), ANTERIOR THORACIC EXTENSION                                                          C       19860101    19960101


L1230            ADDITION TO TLSO, (LOW PROFILE), MILWAUKEE TYPE SUPERSTRUCTURE                                                        C       19860101    19960101


L1240            ADDITION TO TLSO, (LOW PROFILE), LUMBAR DEROTATION PAD                                                                C       19880101    19960101


L1250            ADDITION TO TLSO, (LOW PROFILE), ANTERIOR ASIS PAD                                                                    C       19880101    19960101


L1260            ADDITION TO TLSO, (LOW PROFILE), ANTERIOR THORACIC DEROTATION PAD                                                     C       19880101    19960101


L1270            ADDITION TO TLSO, (LOW PROFILE), ABDOMINAL PAD                                                                        C       19880101    19960101


L1280            ADDITION TO TLSO, (LOW PROFILE), RIB GUSSET (ELASTIC), EACH                                                           C       19880101    19960101


L1290            ADDITION TO TLSO, (LOW PROFILE), LATERAL TROCHANTERIC PAD                                                             C       19880101    19960101


L1300            OTHER SCOLIOSIS PROCEDURE, BODY JACKET MOLDED TO PATIENT MODEL                                                        C       19860101    19960101




                                                         Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date


L1310            OTHER SCOLIOSIS PROCEDURE, POST-OPERATIVE BODY JACKET                                                                C       19860101    19960101


L1499            SPINAL ORTHOSIS, NOT OTHERWISE SPECIFIED                                                                             C       19820101    19980101


L1500     C      THORACIC-HIP-KNEE-ANKLE ORTHOSIS (THKAO), MOBILITY FRAME (NEWINGTON, PARAPODIUM TYPES)                               C       19860101    20120101


L1510     C      THKAO, STANDING FRAME, WITH OR WITHOUT TRAY AND ACCESSORIES                                                          C       19820101    20120101


L1520     C      THKAO, SWIVEL WALKER                                                                                                 C       19820101    20120101


                 HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, FLEXIBLE, FREJKA TYPE WITH COVER, PREFABRICATED,
L1600                                                                                                                                 C       19860101    20010101
                 INCLUDES FITTING AND ADJUSTMENT

                 HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, FLEXIBLE, (FREJKA COVER ONLY), PREFABRICATED,
L1610                                                                                                                                 C       19820101    20010101
                 INCLUDES FITTING AND ADJUSTMENT

                 HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, FLEXIBLE, (PAVLIK HARNESS), PREFABRICATED,
L1620                                                                                                                                 C       19820101    20010101
                 INCLUDES FITTING AND ADJUSTMENT

                 HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, SEMI-FLEXIBLE (VON ROSEN TYPE), CUSTOM-
L1630                                                                                                                                 C       19820101    20010101
                 FABRICATED

                 HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, STATIC, PELVIC BAND OR SPREADER BAR, THIGH CUFFS,
L1640                                                                                                                                 C       19820101    20010101
                 CUSTOM-FABRICATED

                 HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, STATIC, ADJUSTABLE, (ILFLED TYPE), PREFABRICATED,
L1650                                                                                                                                 C       19820101    20010101
                 INCLUDES FITTING AND ADJUSTMENT

                 HIP ORTHOSIS, BILATERAL THIGH CUFFS WITH ADJUSTABLE ABDUCTOR SPREADER BAR, ADULT SIZE,
L1652                                                                                                                                 C       20030101    20030101
                 PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT, ANY TYPE

                 HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, STATIC, PLASTIC, PREFABRICATED, INCLUDES FITTING
L1660                                                                                                                                 C       19820101    20010101
                 AND ADJUSTMENT


L1680            HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, DYNAMIC, PELVIC CONTROL,                                              C       19820101    20010101


L1680            ADJUSTABLE HIP MOTION CONTROL, THIGH CUFFS (RANCHO HIP ACTION TYPE), CUSTOM FABRICATED


                 HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINT, POSTOPERATIVE HIP ABDUCTION TYPE, CUSTOM
L1685                                                                                                                                 C       19880101    20010101
                 FABRICATED

                 HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINT, POSTOPERATIVE HIP ABDUCTION TYPE, PREFABRICATED,
L1686                                                                                                                                 C       19890101    20010101
                 INCLUDES FITTING AND ADJUSTMENT

                 COMBINATION, BILATERAL, LUMBO-SACRAL, HIP, FEMUR ORTHOSIS PROVIDING ADDUCTION AND INTERNAL
L1690                                                                                                                                 C       19990101    20010101
                 ROTATION CONTROL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT



                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date


L1700            LEGG PERTHES ORTHOSIS, (TORONTO TYPE), CUSTOM-FABRICATED                                                             C       19820101    20010101


L1710            LEGG PERTHES ORTHOSIS, (NEWINGTON TYPE), CUSTOM FABRICATED                                                           C       19820101    20010101


L1720            LEGG PERTHES ORTHOSIS, TRILATERAL, (TACHDIJAN TYPE), CUSTOM-FABRICATED                                               C       19850101    20010101


L1730            LEGG PERTHES ORTHOSIS, (SCOTTISH RITE TYPE), CUSTOM-FABRICATED                                                       C       19820101    20010101


                 LEGG PERTHES ORTHOSIS, LEGG PERTHES SLING (SAM BROWN TYPE), PREFABRICATED, INCLUDES FITTING
L1750     D                                                                                                                           C       19820101    20060101     20051231
                 AND ADJUSTMENT


L1755            LEGG PERTHES ORTHOSIS, (PATTEN BOTTOM TYPE), CUSTOM-FABRICATED                                                       C       19880101    20010101


L1800     D      KNEE ORTHOSIS, ELASTIC WITH STAYS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                    C       19860101    20010101     20091231


L1810            KNEE ORTHOSIS, ELASTIC WITH JOINTS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                   C       19820101    20010101


                 KNEE ORTHOSIS, ELASTIC OR OTHER ELASTIC TYPE MATERIAL WITH CONDYLAR PAD(S), PREFABRICATED,
L1815     D                                                                                                                           C       19880101    20010101     20091231
                 INCLUDES FITTING AND ADJUSTMENT

                 KNEE ORTHOSIS, ELASTIC WITH CONDYLAR PADS AND JOINTS, WITH OR WITHOUT PATELLAR CONTROL,
L1820                                                                                                                                 C       19860101    20050101
                 PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT


L1825     D      KNEE ORTHOSIS, ELASTIC KNEE CAP, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                      C       19850101    20010101     20091231


                 KNEE ORTHOSIS, IMMOBILIZER, CANVAS LONGITUDINAL, PREFABRICATED, INCLUDES FITTING AND
L1830                                                                                                                                 C       19860101    20010101
                 ADJUSTMENT

                 KNEE ORTHOSIS, LOCKING KNEE JOINT(S), POSITIONAL ORTHOSIS, PREFABRICATED, INCLUDES FITTING AND
L1831                                                                                                                                 C       20040101    20040101
                 ADJUSTMENT

                 KNEE ORTHOSIS, ADJUSTABLE KNEE JOINTS (UNICENTRIC OR POLYCENTRIC), POSITIONAL ORTHOSIS, RIGID
L1832                                                                                                                                 C       19890101    20060101
                 SUPPORT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT


L1834            KNEE ORTHOSIS, WITHOUT KNEE JOINT, RIGID, CUSTOM-FABRICATED                                                          C       19890101    20010101


                 KNEE ORTHOSIS, RIGID, WITHOUT JOINT(S), INCLUDES SOFT INTERFACE MATERIAL, PREFABRICATED,
L1836                                                                                                                                 C       20030101    20030101
                 INCLUDES FITTING AND ADJUSTMENT


L1840            KNEE ORTHOSIS, DEROTATION, MEDIAL-LATERAL, ANTERIOR CRUCIATE LIGAMENT, CUSTOM FABRICATED                             C       19860101    20010101


                 KNEE ORTHOSIS, SINGLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND EXTENSION JOINT
L1843            (UNICENTRIC OR POLYCENTRIC), MEDIAL-LATERAL AND ROTATION CONTROL, WITH OR WITHOUT                                    C       19980101    20060101
                 VARUS/VALGUS ADJUSTMENT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT


                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                               Code Add   Action Eff
HCPCS            Long Description                                                                                                 Coverage                           Term Date
        Code                                                                                                                                   Date       Date

                 KNEE ORTHOSIS, SINGLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND EXTENSION JOINT
L1844            (UNICENTRIC OR POLYCENTRIC), MEDIAL-LATERAL AND ROTATION CONTROL, WITH OR WITHOUT                                   C       19930101    20060101
                 VARUS/VALGUS ADJUSTMENT, CUSTOM FABRICATED

                 KNEE ORTHOSIS, DOUBLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND EXTENSION JOINT
L1845            (UNICENTRIC OR POLYCENTRIC), MEDIAL-LATERAL AND ROTATION CONTROL, WITH OR WITHOUT                                   C       19880101    20060101
                 VARUS/VALGUS ADJUSTMENT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 KNEE ORTHOSIS, DOUBLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND EXTENSION JOINT
L1846            (UNICENTRIC OR POLYCENTRIC), MEDIAL-LATERAL AND ROTATION CONTROL, WITH OR WITHOUT                                   C       19880101    20060101
                 VARUS/VALGUS ADJUSTMENT, CUSTOM FABRICATED

                 KNEE ORTHOSIS, DOUBLE UPRIGHT WITH ADJUSTABLE JOINT, WITH INFLATABLE AIR SUPPORT CHAMBER(S),
L1847                                                                                                                                C       19990101    20010101
                 PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT


L1850            KNEE ORTHOSIS, SWEDISH TYPE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                         C       19820101    20010101


                 KNEE ORTHOSIS, MOLDED PLASTIC, THIGH AND CALF SECTIONS, WITH DOUBLE UPRIGHT KNEE JOINTS,
L1855     D                                                                                                                          C       19880101    20080101     20071231
                 CUSTOM-FABRICATED

                 KNEE ORTHOSIS, MOLDED PLASTIC, POLYCENTRIC KNEE JOINTS, PNEUMATIC KNEE PADS (CTI), CUSTOM-
L1858     D                                                                                                                          C       19880101    20080101     20071231
                 FABRICATED


L1860            KNEE ORTHOSIS, MODIFICATION OF SUPRACONDYLAR PROSTHETIC SOCKET, CUSTOM-FABRICATED (SK)                              C       19820101    20010101


L1870     D      KNEE ORTHOSIS, DOUBLE UPRIGHT, THIGH AND CALF LACERS WITH KNEE JOINTS, CUSTOM-FABRICATED                            C       19820101    20080101     20071231


                 KNEE ORTHOSIS, DOUBLE UPRIGHT, NON-MOLDED THIGH AND CALF CUFFS/LACERS WITH KNEE JOINTS,
L1880     D                                                                                                                          C       19820101    20080101     20071231
                 CUSTOM-FABRICATED

                 KNEE ORTHOSIS, SINGLE OR DOUBLE UPRIGHT, THIGH AND CALF, WITH FUNCTIONAL ACTIVE RESISTANCE
L1885     D                                                                                                                          C       19960101    20040101     20031231
                 CONTROL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT


L1900            ANKLE FOOT ORTHOSIS, SPRING WIRE, DORSIFLEXION ASSIST CALF BAND, CUSTOM-FABRICATED                                  C       19860101    20010101


L1901     D      ANKLE ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRENE, LYCRA)                      C       20030101    20030101     20091231


L1902            ANKLE FOOT ORTHOSIS, ANKLE GAUNTLET, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                 C       19880101    20010101


L1904            ANKLE FOOT ORTHOSIS, MOLDED ANKLE GAUNTLET, CUSTOM-FABRICATED                                                       C       19880101    20010101


                 ANKLE FOOT ORTHOSIS, MULTILIGAMENTUS ANKLE SUPPORT, PREFABRICATED, INCLUDES FITTING AND
L1906                                                                                                                                C       19880101    20010101
                 ADJUSTMENT


L1907            AFO, SUPRAMALLEOLAR WITH STRAPS, WITH OR WITHOUT INTERFACE/PADS, CUSTOM FABRICATED                                  C       20040101    20040101




                                                       Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date

                 ANKLE FOOT ORTHOSIS, POSTERIOR, SINGLE BAR, CLASP ATTACHMENT TO SHOE COUNTER, PREFABRICATED,
L1910                                                                                                                                 C       19820101    20010101
                 INCLUDES FITTING AND ADJUSTMENT

                 ANKLE FOOT ORTHOSIS, SINGLE UPRIGHT WITH STATIC OR ADJUSTABLE STOP (PHELPS OR PERLSTEIN TYPE),
L1920                                                                                                                                 C       19820101    20010101
                 CUSTOM-FABRICATED

                 ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL, PREFABRICATED, INCLUDES FITTING AND
L1930                                                                                                                                 C       19820101    20020101
                 ADJUSTMENT

                 AFO, RIGID ANTERIOR TIBIAL SECTION, TOTAL CARBON FIBER OR EQUAL MATERIAL, PREFABRICATED,
L1932                                                                                                                                 C       20050101    20050101
                 INCLUDES FITTING AND ADJUSTMENT


L1940            ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL, CUSTOM-FABRICATED                                                    C       19820101    20020101


L1945            ANKLE FOOT ORTHOSIS, PLASTIC, RIGID ANTERIOR TIBIAL SECTION (FLOOR REACTION), CUSTOM-FABRICATED                      C       19890101    20010101


                 ANKLE FOOT ORTHOSIS, SPIRAL, (INSTITUTE OF REHABILITATIVE MEDICINE TYPE), PLASTIC CUSTOM-
L1950                                                                                                                                 C       19820101    20040101
                 FABRICATED

                 ANKLE FOOT ORTHOSIS, SPIRAL, (INSTITUTE OF REHABILITATIVE MEDICINE TYPE), PLASTIC OR OTHER
L1951                                                                                                                                 C       20040101    20040101
                 MATERIAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT


L1960            ANKLE FOOT ORTHOSIS, POSTERIOR SOLID ANKLE, PLASTIC, CUSTOM-FABRICATED                                               C       19820101    20010101


L1970            ANKLE FOOT ORTHOSIS, PLASTIC WITH ANKLE JOINT, CUSTOM-FABRICATED                                                     C       19820101    20010101


                 ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL WITH ANKLE JOINT, PREFABRICATED, INCLUDES
L1971                                                                                                                                 C       20040101    20040101
                 FITTING AND ADJUSTMENT

                 ANKLE FOOT ORTHOSIS, SINGLE UPRIGHT FREE PLANTAR DORSIFLEXION, SOLID STIRRUP, CALF BAND/CUFF
L1980                                                                                                                                 C       19820101    20010101
                 (SINGLE BAR 'BK' ORTHOSIS), CUSTOM-FABRICATED

                 ANKLE FOOT ORTHOSIS, DOUBLE UPRIGHT FREE PLANTAR DORSIFLEXION, SOLID STIRRUP, CALF BAND/CUFF
L1990                                                                                                                                 C       19820101    20010101
                 (DOUBLE BAR 'BK' ORTHOSIS), CUSTOM-FABRICATED

                 KNEE ANKLE FOOT ORTHOSIS, SINGLE UPRIGHT, FREE KNEE, FREE ANKLE, SOLID STIRRUP, THIGH AND CALF
L2000                                                                                                                                 C       19850101    20010101
                 BANDS/CUFFS (SINGLE BAR 'AK' ORTHOSIS), CUSTOM-FABRICATED

                 KNEE ANKLE FOOT ORTHOSIS, ANY MATERIAL, SINGLE OR DOUBLE UPRIGHT, STANCE CONTROL, AUTOMATIC
L2005     C      LOCK AND SWING PHASE RELEASE, ANY TYPE ACTIVATION, INCLUDES ANKLE JOINT, ANY TYPE, CUSTOM                            C       20050101    20120101
                 FABRICATED

                 KNEE ANKLE FOOT ORTHOSIS, SINGLE UPRIGHT, FREE ANKLE, SOLID STIRRUP, THIGH AND CALF BANDS/CUFFS
L2010                                                                                                                                 C       19860101    20010101
                 (SINGLE BAR 'AK' ORTHOSIS), WITHOUT KNEE JOINT, CUSTOM-FABRICATED

                 KNEE ANKLE FOOT ORTHOSIS, DOUBLE UPRIGHT, FREE ANKLE, SOLID STIRRUP, THIGH AND CALF
L2020                                                                                                                                 C       19850101    20010101
                 BANDS/CUFFS (DOUBLE BAR 'AK' ORTHOSIS), CUSTOM-FABRICATED

                 KNEE ANKLE FOOT ORTHOSIS, DOUBLE UPRIGHT, FREE ANKLE, SOLID STIRRUP, THIGH AND CALF
L2030                                                                                                                                 C       19860101    20010101
                 BANDS/CUFFS, (DOUBLE BAR 'AK' ORTHOSIS), WITHOUT KNEE JOINT, CUSTOM FABRICATED


                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date

                 KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, SINGLE UPRIGHT, WITH OR WITHOUT FREE MOTION KNEE,
L2034                                                                                                                                 C       20060101    20060101
                 MEDIAL LATERAL ROTATION CONTROL, WITH OR WITHOUT FREE MOTION ANKLE, CUSTOM FABRICATED

                 KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, STATIC (PEDIATRIC SIZE), WITHOUT FREE MOTION ANKLE,
L2035                                                                                                                                 C       19980101    20050101
                 PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, DOUBLE UPRIGHT, WITH OR WITHOUT FREE MOTION KNEE, WITH
L2036                                                                                                                                 C       19880101    20060101
                 OR WITHOUT FREE MOTION ANKLE, CUSTOM FABRICATED

                 KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, SINGLE UPRIGHT, WITH OR WITHOUT FREE MOTION KNEE, WITH
L2037                                                                                                                                 C       19890101    20060101
                 OR WITHOUT FREE MOTION ANKLE, CUSTOM FABRICATED

                 KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, WITH OR WITHOUT FREE MOTION KNEE, MULTI-AXIS ANKLE,
L2038                                                                                                                                 C       19890101    20060101
                 CUSTOM FABRICATED

                 KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, SINGLE UPRIGHT, POLY-AXIAL HINGE, MEDIAL LATERAL
L2039     D                                                                                                                           C       19970101    20060101     20051231
                 ROTATION CONTROL, WITH OR WITHOUT FREE MOTION ANKLE, CUSTOM FABRICATED

                 HIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, BILATERAL ROTATION STRAPS, PELVIC BAND/BELT,
L2040                                                                                                                                 C       19860101    20010101
                 CUSTOM FABRICATED

                 HIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, BILATERAL TORSION CABLES, HIP JOINT, PELVIC
L2050                                                                                                                                 C       19820101    20010101
                 BAND/BELT, CUSTOM-FABRICATED

                 HIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, BILATERAL TORSION CABLES, BALL BEARING HIP JOINT,
L2060                                                                                                                                 C       19820101    20010101
                 PELVIC BAND/ BELT, CUSTOM-FABRICATED

                 HIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, UNILATERAL ROTATION STRAPS, PELVIC BAND/BELT,
L2070                                                                                                                                 C       19820101    20010101
                 CUSTOM FABRICATED

                 HIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, UNILATERAL TORSION CABLE, HIP JOINT, PELVIC
L2080                                                                                                                                 C       19860101    20010101
                 BAND/BELT, CUSTOM-FABRICATED

                 HIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, UNILATERAL TORSION CABLE, BALL BEARING HIP
L2090                                                                                                                                 C       19840101    20010101
                 JOINT, PELVIC BAND/ BELT, CUSTOM-FABRICATED

                 ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE CAST ORTHOSIS, PLASTER TYPE CASTING
L2102     D                                                                                                                           I       19880101    20040101     20031231
                 MATERIAL, CUSTOM-FABRICATED

                 ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE CAST ORTHOSIS, SYNTHETIC TYPE CASTING
L2104     D                                                                                                                           I       19880101    20040101     20031231
                 MATERIAL, CUSTOM-FABRICATED

                 ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE CAST ORTHOSIS, THERMOPLASTIC TYPE
L2106                                                                                                                                 C       19880101    20010101
                 CASTING MATERIAL, CUSTOM-FABRICATED


L2108            ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE CAST ORTHOSIS, CUSTOM-FABRICATED                             C       19880101    20010101


                 ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, SOFT, PREFABRICATED,
L2112                                                                                                                                 C       19880101    20010101
                 INCLUDES FITTING AND ADJUSTMENT

                 ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, SEMI-RIGID, PREFABRICATED,
L2114                                                                                                                                 C       19880101    20010101
                 INCLUDES FITTING AND ADJUSTMENT



                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date

                 ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, RIGID, PREFABRICATED,
L2116                                                                                                                                 C       19880101    20010101
                 INCLUDES FITTING AND ADJUSTMENT

                 KNEE ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, PLASTER TYPE
L2122     D                                                                                                                           I       19880101    20040101     20031231
                 CASTING MATERIAL, CUSTOM-FABRICATED

                 KNEE ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, SYNTHETIC TYPE
L2124     D                                                                                                                           I       19880101    20040101     20031231
                 CASTING MATERIAL, CUSTOM-FABRICATED

                 KNEE ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, THERMOPLASTIC
L2126                                                                                                                                 C       19880101    20010101
                 TYPE CASTING MATERIAL, CUSTOM-FABRICATED

                 KNEE ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, CUSTOM-
L2128                                                                                                                                 C       19880101    20010101
                 FABRICATED

                 KAFO, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, SOFT, PREFABRICATED, INCLUDES
L2132                                                                                                                                 C       19880101    20010101
                 FITTING AND ADJUSTMENT

                 KAFO, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, SEMI-RIGID, PREFABRICATED, INCLUDES
L2134                                                                                                                                 C       19880101    20010101
                 FITTING AND ADJUSTMENT

                 KAFO, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, RIGID, PREFABRICATED, INCLUDES
L2136                                                                                                                                 C       19880101    20010101
                 FITTING AND ADJUSTMENT


L2180            ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, PLASTIC SHOE INSERT WITH ANKLE JOINTS                                 C       19880101    19960101


L2182            ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, DROP LOCK KNEE JOINT                                                  C       19880101    19960101


L2184            ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, LIMITED MOTION KNEE JOINT                                             C       19880101    19960101


L2186            ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, ADJUSTABLE MOTION KNEE JOINT, LERMAN TYPE                             C       19880101    19960101


L2188            ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, QUADRILATERAL BRIM                                                    C       19880101    19960101


L2190            ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, WAIST BELT                                                            C       19880101    19960101


                 ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, HIP JOINT, PELVIC BAND, THIGH FLANGE, AND PELVIC
L2192                                                                                                                                 C       19880101    19960101
                 BELT


L2200            ADDITION TO LOWER EXTREMITY, LIMITED ANKLE MOTION, EACH JOINT                                                        C       19860101    19960101


L2210            ADDITION TO LOWER EXTREMITY, DORSIFLEXION ASSIST (PLANTAR FLEXION RESIST), EACH JOINT                                C       19860101    19960101


L2220            ADDITION TO LOWER EXTREMITY, DORSIFLEXION AND PLANTAR FLEXION ASSIST/RESIST, EACH JOINT                              C       19860101    19960101




                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                               Code Add   Action Eff
HCPCS            Long Description                                                                                                 Coverage                           Term Date
        Code                                                                                                                                   Date       Date


L2230            ADDITION TO LOWER EXTREMITY, SPLIT FLAT CALIPER STIRRUPS AND PLATE ATTACHMENT                                       C       19860101    19960101


                 ADDITION TO LOWER EXTREMITY ORTHOSIS, ROCKER BOTTOM FOR TOTAL CONTACT ANKLE FOOT ORTHOSIS,
L2232                                                                                                                                C       20050101    20050101
                 FOR CUSTOM FABRICATED ORTHOSIS ONLY


L2240            ADDITION TO LOWER EXTREMITY, ROUND CALIPER AND PLATE ATTACHMENT                                                     C       19860101    19960101


L2250            ADDITION TO LOWER EXTREMITY, FOOT PLATE, MOLDED TO PATIENT MODEL, STIRRUP ATTACHMENT                                C       19860101    19960101


L2260            ADDITION TO LOWER EXTREMITY, REINFORCED SOLID STIRRUP (SCOTT-CRAIG TYPE)                                            C       19860101    19960101


L2265            ADDITION TO LOWER EXTREMITY, LONG TONGUE STIRRUP                                                                    C       19890101    19960101


                 ADDITION TO LOWER EXTREMITY, VARUS/VALGUS CORRECTION ('T') STRAP, PADDED/LINED OR MALLEOLUS
L2270                                                                                                                                C       19860101    19960101
                 PAD


L2275            ADDITION TO LOWER EXTREMITY, VARUS/VALGUS CORRECTION, PLASTIC MODIFICATION, PADDED/LINED                            C       19940101    19960101


L2280            ADDITION TO LOWER EXTREMITY, MOLDED INNER BOOT                                                                      C       19860101    19960101


L2300            ADDITION TO LOWER EXTREMITY, ABDUCTION BAR (BILATERAL HIP INVOLVEMENT), JOINTED, ADJUSTABLE                         C       19860101    19960101


L2310            ADDITION TO LOWER EXTREMITY, ABDUCTION BAR-STRAIGHT                                                                 C       19860101    19960101


L2320            ADDITION TO LOWER EXTREMITY, NON-MOLDED LACER, FOR CUSTOM FABRICATED ORTHOSIS ONLY                                  C       19860101    20050101


                 ADDITION TO LOWER EXTREMITY, LACER MOLDED TO PATIENT MODEL, FOR CUSTOM FABRICATED ORTHOSIS
L2330                                                                                                                                C       19860101    20050101
                 ONLY


L2335            ADDITION TO LOWER EXTREMITY, ANTERIOR SWING BAND                                                                    C       19880101    19960101


L2340            ADDITION TO LOWER EXTREMITY, PRE-TIBIAL SHELL, MOLDED TO PATIENT MODEL                                              C       19860101    19960101


                 ADDITION TO LOWER EXTREMITY, PROSTHETIC TYPE, (BK) SOCKET, MOLDED TO PATIENT MODEL, (USED FOR
L2350                                                                                                                                C       19860101    19960101
                 'PTB' 'AFO' ORTHOSES)


L2360            ADDITION TO LOWER EXTREMITY, EXTENDED STEEL SHANK                                                                   C       19860101    19960101


L2370            ADDITION TO LOWER EXTREMITY, PATTEN BOTTOM                                                                          C       19880101    19960101




                                                       Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                   Code Add   Action Eff
HCPCS            Long Description                                                                                                     Coverage                           Term Date
        Code                                                                                                                                       Date       Date


L2375            ADDITION TO LOWER EXTREMITY, TORSION CONTROL, ANKLE JOINT AND HALF SOLID STIRRUP                                        C       19880101    19960101


L2380            ADDITION TO LOWER EXTREMITY, TORSION CONTROL, STRAIGHT KNEE JOINT, EACH JOINT                                           C       19880101    19960101


L2385            ADDITION TO LOWER EXTREMITY, STRAIGHT KNEE JOINT, HEAVY DUTY, EACH JOINT                                                C       19880101    19960101


                 ADDITION TO LOWER EXTREMITY, POLYCENTRIC KNEE JOINT, FOR CUSTOM FABRICATED KNEE ANKLE FOOT
L2387                                                                                                                                    C       20060101    20060101
                 ORTHOSIS, EACH JOINT


L2390            ADDITION TO LOWER EXTREMITY, OFFSET KNEE JOINT, EACH JOINT                                                              C       19880101    19960101


L2395            ADDITION TO LOWER EXTREMITY, OFFSET KNEE JOINT, HEAVY DUTY, EACH JOINT                                                  C       19880101    19960101


L2397            ADDITION TO LOWER EXTREMITY ORTHOSIS, SUSPENSION SLEEVE                                                                 C       19940101    19960101


L2405            ADDITION TO KNEE JOINT, DROP LOCK, EACH                                                                                 C       19880101    20060101


                 ADDITION TO KNEE LOCK WITH INTEGRATED RELEASE MECHANISM ( BAIL, CABLE, OR EQUAL), ANY MATERIAL,
L2415                                                                                                                                    C       19880101    20020101
                 EACH JOINT


L2425            ADDITION TO KNEE JOINT, DISC OR DIAL LOCK FOR ADJUSTABLE KNEE FLEXION, EACH JOINT                                       C       19880101    19960101


L2430            ADDITION TO KNEE JOINT, RATCHET LOCK FOR ACTIVE AND PROGRESSIVE KNEE EXTENSION, EACH JOINT                              C       19970101    19970101


L2435     D      ADDITION TO KNEE JOINT, POLYCENTRIC JOINT, EACH JOINT                                                                   C       19880101    20050101     20041231


L2492            ADDITION TO KNEE JOINT, LIFT LOOP FOR DROP LOCK RING                                                                    C       19880101    19960101


L2500            ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, GLUTEAL/ ISCHIAL WEIGHT BEARING, RING                                C       19860101    19960101


                 ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, QUADRI- LATERAL BRIM, MOLDED TO PATIENT
L2510                                                                                                                                    C       19860101    19960101
                 MODEL


L2520            ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, QUADRI- LATERAL BRIM, CUSTOM FITTED                                  C       19860101    19960101


                 ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, ISCHIAL CONTAINMENT/NARROW M-L BRIM
L2525                                                                                                                                    C       19890101    19960101
                 MOLDED TO PATIENT MODEL

                 ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, ISCHIAL CONTAINMENT/NARROW M-L BRIM,
L2526                                                                                                                                    C       19890101    19960101
                 CUSTOM FITTED



                                                           Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date


L2530            ADDITION TO LOWER EXTREMITY, THIGH-WEIGHT BEARING, LACER, NON-MOLDED                                                 C       19860101    19960101


L2540            ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, LACER, MOLDED TO PATIENT MODEL                                    C       19860101    19960101


L2550            ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, HIGH ROLL CUFF                                                    C       19860101    19960101


L2570            ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, CLEVIS TYPE TWO POSITION JOINT, EACH                         C       19860101    19960101


L2580            ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, PELVIC SLING                                                            C       19860101    19960101


                 ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, CLEVIS TYPE, OR THRUST BEARING, FREE,
L2600                                                                                                                                 C       19860101    19960101
                 EACH


L2610            ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, CLEVIS OR THRUST BEARING, LOCK, EACH                         C       19860101    19960101


L2620            ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, HEAVY DUTY, EACH                                             C       19860101    19960101


L2622            ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, ADJUSTABLE FLEXION, EACH                                     C       19880101    19960101


                 ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, ADJUSTABLE FLEXION, EXTENSION,
L2624                                                                                                                                 C       19880101    19960101
                 ABDUCTION CONTROL, EACH

                 ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, PLASTIC, MOLDED TO PATIENT MODEL, RECIPROCATING
L2627                                                                                                                                 C       19890101    19960101
                 HIP JOINT AND CABLES


L2628            ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, METAL FRAME, RECIPROCATING HIP JOINT AND CABLES                         C       19890101    19960101


L2630            ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, BAND AND BELT, UNILATERAL                                               C       19860101    19960101


L2640            ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, BAND AND BELT, BILATERAL                                                C       19860101    19960101


L2650            ADDITION TO LOWER EXTREMITY, PELVIC AND THORACIC CONTROL, GLUTEAL PAD, EACH                                          C       19860101    19960101


L2660            ADDITION TO LOWER EXTREMITY, THORACIC CONTROL, THORACIC BAND                                                         C       19860101    19960101


L2670            ADDITION TO LOWER EXTREMITY, THORACIC CONTROL, PARASPINAL UPRIGHTS                                                   C       19860101    19960101


L2680            ADDITION TO LOWER EXTREMITY, THORACIC CONTROL, LATERAL SUPPORT UPRIGHTS                                              C       19860101    19960101




                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                               Code Add   Action Eff
HCPCS            Long Description                                                                                                 Coverage                           Term Date
        Code                                                                                                                                   Date       Date


L2750            ADDITION TO LOWER EXTREMITY ORTHOSIS, PLATING CHROME OR NICKEL, PER BAR                                             C       19860101    19960101


                 ADDITION TO LOWER EXTREMITY ORTHOSIS, HIGH STRENGTH, LIGHTWEIGHT MATERIAL, ALL HYBRID
L2755                                                                                                                                C       19970101    20050101
                 LAMINATION/PREPREG COMPOSITE, PER SEGMENT, FOR CUSTOM FABRICATED ORTHOSIS ONLY

                 ADDITION TO LOWER EXTREMITY ORTHOSIS, EXTENSION, PER EXTENSION, PER BAR (FOR LINEAL
L2760                                                                                                                                C       19860101    19960101
                 ADJUSTMENT FOR GROWTH)


L2768            ORTHOTIC SIDE BAR DISCONNECT DEVICE, PER BAR                                                                        C       20020101    20020101


L2770     D      ADDITION TO LOWER EXTREMITY ORTHOSIS, ANY MATERIAL - PER BAR OR JOINT                                               C       19860101    19960101     20091231


L2780            ADDITION TO LOWER EXTREMITY ORTHOSIS, NON-CORROSIVE FINISH, PER BAR                                                 C       19860101    19960101


L2785            ADDITION TO LOWER EXTREMITY ORTHOSIS, DROP LOCK RETAINER, EACH                                                      C       19880101    19960101


L2795            ADDITION TO LOWER EXTREMITY ORTHOSIS, KNEE CONTROL, FULL KNEECAP                                                    C       19880101    19960101


                 ADDITION TO LOWER EXTREMITY ORTHOSIS, KNEE CONTROL, KNEE CAP, MEDIAL OR LATERAL PULL, FOR USE
L2800                                                                                                                                C       19880101    20050101
                 WITH CUSTOM FABRICATED ORTHOSIS ONLY


L2810            ADDITION TO LOWER EXTREMITY ORTHOSIS, KNEE CONTROL, CONDYLAR PAD                                                    C       19880101    19960101


L2820            ADDITION TO LOWER EXTREMITY ORTHOSIS, SOFT INTERFACE FOR MOLDED PLASTIC, BELOW KNEE SECTION                         C       19880101    19960101


L2830            ADDITION TO LOWER EXTREMITY ORTHOSIS, SOFT INTERFACE FOR MOLDED PLASTIC, ABOVE KNEE SECTION                         C       19880101    19960101


L2840            ADDITION TO LOWER EXTREMITY ORTHOSIS, TIBIAL LENGTH SOCK, FRACTURE OR EQUAL, EACH                                   C       19890101    19960101


L2850            ADDITION TO LOWER EXTREMITY ORTHOSIS, FEMORAL LENGTH SOCK, FRACTURE OR EQUAL, EACH                                  C       19890101    19960101


                 ADDITION TO LOWER EXTREMITY JOINT, KNEE OR ANKLE, CONCENTRIC ADJUSTABLE TORSION STYLE
L2860     D                                                                                                                          C       19950101    19980312     20081231
                 MECHANISM, EACH


L2999            LOWER EXTREMITY ORTHOSES, NOT OTHERWISE SPECIFIED                                                                   C       19820101    19980101


L3000            FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, 'UCB' TYPE, BERKELEY SHELL, EACH                                  D       19820101    19970101


L3001            FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, SPENCO, EACH                                                      D       19840101    19970101




                                                       Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date


L3002            FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, PLASTAZOTE OR EQUAL, EACH                                          D       19840101    19970101


L3003            FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, SILICONE GEL, EACH                                                 D       19840101    19970101


L3010            FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, LONGITUDINAL ARCH SUPPORT, EACH                                    D       19820101    19970101


L3020            FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, LONGITUDINAL/ METATARSAL SUPPORT, EACH                             D       19860101    19970101


L3030            FOOT, INSERT, REMOVABLE, FORMED TO PATIENT FOOT, EACH                                                                D       19860101    19970101


                 FOOT, INSERT/PLATE, REMOVABLE, ADDITION TO LOWER EXTREMITY ORTHOSIS, HIGH STRENGTH,
L3031                                                                                                                                 C       20040101    20050101
                 LIGHTWEIGHT MATERIAL, ALL HYBRID LAMINATION/PREPREG COMPOSITE, EACH


L3040            FOOT, ARCH SUPPORT, REMOVABLE, PREMOLDED, LONGITUDINAL, EACH                                                         D       19820101    19970101


L3050            FOOT, ARCH SUPPORT, REMOVABLE, PREMOLDED, METATARSAL, EACH                                                           D       19820101    19970101


L3060            FOOT, ARCH SUPPORT, REMOVABLE, PREMOLDED, LONGITUDINAL/ METATARSAL, EACH                                             D       19820101    19970101


L3070            FOOT, ARCH SUPPORT, NON-REMOVABLE ATTACHED TO SHOE, LONGITUDINAL, EACH                                               D       19840101    19970101


L3080            FOOT, ARCH SUPPORT, NON-REMOVABLE ATTACHED TO SHOE, METATARSAL, EACH                                                 D       19840101    19970101


L3090            FOOT, ARCH SUPPORT, NON-REMOVABLE ATTACHED TO SHOE, LONGITUDINAL/METATARSAL, EACH                                    D       19840101    19970101


L3100            HALLUS-VALGUS NIGHT DYNAMIC SPLINT                                                                                   D       19850101    19970101


L3140            FOOT, ABDUCTION ROTATION BAR, INCLUDING SHOES                                                                        D       19820101    19970101


L3150            FOOT, ABDUCTION ROTATATION BAR, WITHOUT SHOES                                                                        D       19840101    19970101


L3160            FOOT, ADJUSTABLE SHOE-STYLED POSITIONING DEVICE                                                                      C       19860101    19950101


L3170            FOOT, PLASTIC, SILICONE OR EQUAL, HEEL STABILIZER, EACH                                                              D       19840101    20060101


L3201            ORTHOPEDIC SHOE, OXFORD WITH SUPINATOR OR PRONATOR, INFANT                                                           D       19840101    19970101




                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                              Code Add   Action Eff
HCPCS            Long Description                                                                                                Coverage                           Term Date
        Code                                                                                                                                  Date       Date


L3202            ORTHOPEDIC SHOE, OXFORD WITH SUPINATOR OR PRONATOR, CHILD                                                          D       19840101    19970101


L3203            ORTHOPEDIC SHOE, OXFORD WITH SUPINATOR OR PRONATOR, JUNIOR                                                         D       19840101    19970101


L3204            ORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR OR PRONATOR, INFANT                                                        D       19840101    19970101


L3206            ORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR OR PRONATOR, CHILD                                                         D       19840101    19970101


L3207            ORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR OR PRONATOR, JUNIOR                                                        D       19840101    19970101


L3208            SURGICAL BOOT, EACH, INFANT                                                                                        D       19840101    19960101


L3209            SURGICAL BOOT, EACH, CHILD                                                                                         D       19840101    19960101


L3211            SURGICAL BOOT, EACH, JUNIOR                                                                                        D       19840101    19960101


L3212            BENESCH BOOT, PAIR, INFANT                                                                                         D       19840101    19960101


L3213            BENESCH BOOT, PAIR, CHILD                                                                                          D       19840101    19960101


L3214            BENESCH BOOT, PAIR, JUNIOR                                                                                         D       19840101    19960101


L3215            ORTHOPEDIC FOOTWEAR, LADIES SHOE, OXFORD, EACH                                                                     S       19840101    20060101


L3216            ORTHOPEDIC FOOTWEAR, LADIES SHOE, DEPTH INLAY, EACH                                                                S       19840101    20060101


L3217            ORTHOPEDIC FOOTWEAR, LADIES SHOE, HIGHTOP, DEPTH INLAY, EACH                                                       S       19840101    20060101


L3219            ORTHOPEDIC FOOTWEAR, MENS SHOE, OXFORD, EACH                                                                       S       19840101    20060101


L3221            ORTHOPEDIC FOOTWEAR, MENS SHOE, DEPTH INLAY, EACH                                                                  S       19840101    20060101


L3222            ORTHOPEDIC FOOTWEAR, MENS SHOE, HIGHTOP, DEPTH INLAY, EACH                                                         S       19840101    20060101


L3224            ORTHOPEDIC FOOTWEAR, WOMAN'S SHOE, OXFORD, USED AS AN INTEGRAL PART OF A BRACE (ORTHOSIS)                          D       19950101    19950101




                                                      Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                    Code Add   Action Eff
HCPCS            Long Description                                                                                                      Coverage                           Term Date
        Code                                                                                                                                        Date       Date


L3225            ORTHOPEDIC FOOTWEAR, MAN'S SHOE, OXFORD, USED AS AN INTEGRAL PART OF A BRACE (ORTHOSIS)                                  D       19950101    19950101


L3230            ORTHOPEDIC FOOTWEAR, CUSTOM SHOE, DEPTH INLAY, EACH                                                                      D       19840101    20060101


L3250            ORTHOPEDIC FOOTWEAR, CUSTOM MOLDED SHOE, REMOVABLE INNER MOLD, PROSTHETIC SHOE, EACH                                     D       19840101    19970101


L3251            FOOT, SHOE MOLDED TO PATIENT MODEL, SILICONE SHOE, EACH                                                                  D       19840101    19970101


L3252            FOOT, SHOE MOLDED TO PATIENT MODEL, PLASTAZOTE (OR SIMILAR), CUSTOM FABRICATED, EACH                                     D       19840101    19970101


L3253            FOOT, MOLDED SHOE PLASTAZOTE (OR SIMILAR) CUSTOM FITTED, EACH                                                            D       19840101    19970101


L3254            NON-STANDARD SIZE OR WIDTH                                                                                               D       19840101    19970101


L3255            NON-STANDARD SIZE OR LENGTH                                                                                              D       19840101    19970101


L3257            ORTHOPEDIC FOOTWEAR, ADDITIONAL CHARGE FOR SPLIT SIZE                                                                    D       19880101    19970101


L3260            SURGICAL BOOT/SHOE, EACH                                                                                                 D       19840101    20030101


L3265            PLASTAZOTE SANDAL, EACH                                                                                                  C       19840101    19960101


L3300            LIFT, ELEVATION, HEEL, TAPERED TO METATARSALS, PER INCH                                                                  D       19860101    19970101


L3310            LIFT, ELEVATION, HEEL AND SOLE, NEOPRENE, PER INCH                                                                       D       19860101    19970101


L3320            LIFT, ELEVATION, HEEL AND SOLE, CORK, PER INCH                                                                           D       19860101    19970101


L3330            LIFT, ELEVATION, METAL EXTENSION (SKATE)                                                                                 D       19860101    19970101


L3332            LIFT, ELEVATION, INSIDE SHOE, TAPERED, UP TO ONE-HALF INCH                                                               D       19860101    19970101


L3334            LIFT, ELEVATION, HEEL, PER INCH                                                                                          D       19860101    19970101


L3340            HEEL WEDGE, SACH                                                                                                         D       19820101    19970101




                                                            Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                              Code Add   Action Eff
HCPCS            Long Description                                                                                                Coverage                           Term Date
        Code                                                                                                                                  Date       Date


L3350            HEEL WEDGE                                                                                                         D       19820101    19970101


L3360            SOLE WEDGE, OUTSIDE SOLE                                                                                           D       19840101    19970101


L3370            SOLE WEDGE, BETWEEN SOLE                                                                                           D       19840101    19970101


L3380            CLUBFOOT WEDGE                                                                                                     D       19820101    19970101


L3390            OUTFLARE WEDGE                                                                                                     D       19820101    19970101


L3400            METATARSAL BAR WEDGE, ROCKER                                                                                       D       19840101    19970101


L3410            METATARSAL BAR WEDGE, BETWEEN SOLE                                                                                 D       19840101    19970101


L3420            FULL SOLE AND HEEL WEDGE, BETWEEN SOLE                                                                             D       19840101    19970101


L3430            HEEL, COUNTER, PLASTIC REINFORCED                                                                                  D       19850101    19970101


L3440            HEEL, COUNTER, LEATHER REINFORCED                                                                                  D       19840101    19970101


L3450            HEEL, SACH CUSHION TYPE                                                                                            D       19840101    19970101


L3455            HEEL, NEW LEATHER, STANDARD                                                                                        D       19840101    19970101


L3460            HEEL, NEW RUBBER, STANDARD                                                                                         D       19840101    19970101


L3465            HEEL, THOMAS WITH WEDGE                                                                                            D       19840101    19970101


L3470            HEEL, THOMAS EXTENDED TO BALL                                                                                      D       19840101    19970101


L3480            HEEL, PAD AND DEPRESSION FOR SPUR                                                                                  D       19840101    19970101


L3485            HEEL, PAD, REMOVABLE FOR SPUR                                                                                      D       19840101    19970101


L3500            ORTHOPEDIC SHOE ADDITION, INSOLE, LEATHER                                                                          D       19860101    19990101




                                                      Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date


L3510            ORTHOPEDIC SHOE ADDITION, INSOLE, RUBBER                                                                             D       19860101    19990101


L3520            ORTHOPEDIC SHOE ADDITION, INSOLE, FELT COVERED WITH LEATHER                                                          D       19860101    19990101


L3530            ORTHOPEDIC SHOE ADDITION, SOLE, HALF                                                                                 D       19860101    19990101


L3540            ORTHOPEDIC SHOE ADDITION, SOLE, FULL                                                                                 D       19860101    19990101


L3550            ORTHOPEDIC SHOE ADDITION, TOE TAP STANDARD                                                                           D       19860101    19990101


L3560            ORTHOPEDIC SHOE ADDITION, TOE TAP, HORSESHOE                                                                         D       19860101    19990101


L3570            ORTHOPEDIC SHOE ADDITION, SPECIAL EXTENSION TO INSTEP (LEATHER WITH EYELETS)                                         D       19860101    19990101


L3580            ORTHOPEDIC SHOE ADDITION, CONVERT INSTEP TO VELCRO CLOSURE                                                           D       19860101    19990101


L3590            ORTHOPEDIC SHOE ADDITION, CONVERT FIRM SHOE COUNTER TO SOFT COUNTER                                                  D       19860101    19990101


L3595            ORTHOPEDIC SHOE ADDITION, MARCH BAR                                                                                  D       19860101    19990101


L3600            TRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, CALIPER PLATE, EXISTING                                            D       19860101    19970101


L3610            TRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, CALIPER PLATE, NEW                                                 D       19860101    19970101


L3620            TRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, SOLID STIRRUP, EXISTING                                            D       19860101    19970101


L3630            TRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, SOLID STIRRUP, NEW                                                 D       19860101    19970101


                 TRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, DENNIS BROWNE SPLINT (RIVETON), BOTH
L3640                                                                                                                                 D       19860101    19970101
                 SHOES


L3649            ORTHOPEDIC SHOE, MODIFICATION, ADDITION OR TRANSFER, NOT OTHERWISE SPECIFIED                                         D       19820101    19990101


                 SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, PREFABRICATED, INCLUDES
L3650                                                                                                                                 C       19860101    20010101
                 FITTING AND ADJUSTMENT

                 SHOULDER ORTHOSIS, SINGLE SHOULDER, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
L3651     D                                                                                                                           C       20030101    20030101     20091231
                 (E.G. NEOPRENE, LYCRA)



                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                               Code Add   Action Eff
HCPCS            Long Description                                                                                                 Coverage                           Term Date
        Code                                                                                                                                   Date       Date

                 SHOULDER ORTHOSIS, DOUBLE SHOULDER, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
L3652     D                                                                                                                          C       20030101    20030101     20091231
                 (E.G. NEOPRENE, LYCRA)

                 SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND WEBBING,
L3660                                                                                                                                C       19820101    20010101
                 PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 SHOULDER ORTHOSIS, ACROMIO/CLAVICULAR (CANVAS AND WEBBING TYPE), PREFABRICATED, INCLUDES
L3670                                                                                                                                C       19820101    20010101
                 FITTING AND ADJUSTMENT

                 SHOULDER ORTHOSIS, SHOULDER JOINT DESIGN, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS,
L3671                                                                                                                                C       20060101    20060101
                 CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 SHOULDER ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN), THORACIC COMPONENT AND SUPPORT
L3672            BAR, WITHOUT JOINTS, MAY INLCUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING                        C       20060101    20060101
                 AND ADJUSTMENT

                 SHOULDER ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN), THORACIC COMPONENT AND SUPPORT
L3673            BAR, INCLUDES NONTORSION JOINT/TURNBUCKLE, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM                               C       20060101    20110101     20101231
                 FABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 SHOULDER ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN), THORACIC COMPONENTAND SUPPORT
L3674            BAR, WITH OR WITHOUT NONTORSION JOINT/TURNBUCKLE, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM                        C       20110101    20110101
                 FABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 SHOULDER ORTHOSIS, VEST TYPE ABDUCTION RESTRAINER, CANVAS WEBBING TYPE OR EQUAL,
L3675                                                                                                                                C       19990101    20010101
                 PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 SHOULDER ORTHOSIS, SHOULDER JOINT DESIGN, WITHOUT JOINTS, MAY INCLUDE SOFTINTERFACE, STRAPS,
L3677                                                                                                                                D       20020101    20020101
                 PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT


L3700     D      ELBOW ORTHOSIS, ELASTIC WITH STAYS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                  C       19820101    20010101     20091231


L3701     D      ELBOW ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRENE, LYCRA)                      C       20030101    20030101     20091231


                 ELBOW ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED,
L3702                                                                                                                                C       20060101    20060101
                 INCLUDES FITTING AND ADJUSTMENT


L3710            ELBOW ORTHOSIS, ELASTIC WITH METAL JOINTS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                           C       19860101    20010101


L3720            ELBOW ORTHOSIS, DOUBLE UPRIGHT WITH FOREARM/ARM CUFFS, FREE MOTION, CUSTOM-FABRICATED                               C       19840101    20010101


                 ELBOW ORTHOSIS, DOUBLE UPRIGHT WITH FOREARM/ARM CUFFS, EXTENSION/ FLEXION ASSIST, CUSTOM-
L3730                                                                                                                                C       19820101    20010101
                 FABRICATED

                 ELBOW ORTHOSIS, DOUBLE UPRIGHT WITH FOREARM/ARM CUFFS, ADJUSTABLE POSITION LOCK WITH ACTIVE
L3740                                                                                                                                C       19820101    20010101
                 CONTROL, CUSTOM-FABRICATED

                 ELBOW ORTHOSIS, WITH ADJUSTABLE POSITION LOCKING JOINT(S), PREFABRICATED, INCLUDES FITTING AND
L3760                                                                                                                                C       20010101    20010101
                 ADJUSTMENTS, ANY TYPE




                                                       Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                               Code Add   Action Eff
HCPCS            Long Description                                                                                                 Coverage                           Term Date
        Code                                                                                                                                   Date       Date

                 ELBOW ORTHOSIS, RIGID, WITHOUT JOINTS, INCLUDES SOFT INTERFACE MATERIAL, PREFABRICATED,
L3762                                                                                                                                C       20030101    20030101
                 INCLUDES FITTING AND ADJUSTMENT

                 ELBOW WRIST HAND ORTHOSIS, RIGID, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM
L3763                                                                                                                                C       20060101    20060101
                 FABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 ELBOW WRIST HAND ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINTS, ELASTIC BANDS,
L3764            TURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND                            C       20060101    20060101
                 ADJUSTMENT

                 ELBOW WRIST HAND FINGER ORTHOSIS, RIGID, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS,
L3765                                                                                                                                C       20060101    20060101
                 CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 ELBOW WRIST HAND FINGER ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINTS, ELASTIC BANDS,
L3766            TURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND                            C       20060101    20060101
                 ADJUSTMENT


L3800     D      WRIST HAND FINGER ORTHOSIS, SHORT OPPONENS, NO ATTACHMENTS, CUSTOM-FABRICATED                                       C       19820101    20080101     20071231


L3805     D      WRIST HAND FINGER ORTHOSIS, LONG OPPONENS, NO ATTACHMENT, CUSTOM-FABRICATED                                         C       19820101    20080101     20071231


                 WRIST HAND FINGER ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINT(S), TURNBUCKLES, ELASTIC
L3806     C      BANDS/SPRINGS, MAY INCLUDE SOFT INTERFACE MATERIAL, STRAPS, CUSTOM FABRICATED, INCLUDES                             C       20070101    20080101
                 FITTING AND ADJUSTMENT

                 WRIST HAND FINGER ORTHOSIS, WITHOUT JOINT(S), PREFABRICATED, INCLUDES FITTING AND ADJUSTMENTS,
L3807                                                                                                                                C       20000101    20010101
                 ANY TYPE

                 WRIST HAND FINGER ORTHOSIS, RIGID WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE MATERIAL; STRAPS,
L3808     A                                                                                                                          C       20070101    20070101
                 CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT


L3810     D      WHFO, ADDITION TO SHORT AND LONG OPPONENS, THUMB ABDUCTION ('C') BAR                                                C       19860101    20080101     20071231


L3815     D      WHFO, ADDITION TO SHORT AND LONG OPPONENS, SECOND M.P. ABDUCTION ASSIST                                             C       19860101    20080101     20071231


L3820     D      WHFO, ADDITION TO SHORT AND LONG OPPONENS, I.P. EXTENSION ASSIST, WITH M.P. EXTENSION STOP                          C       19860101    20080101     20071231


L3825     D      WHFO, ADDITION TO SHORT AND LONG OPPONENS, M.P. EXTENSION STOP                                                      C       19860101    20080101     20071231


L3830     D      WHFO, ADDITION TO SHORT AND LONG OPPONENS, M.P. EXTENSION ASSIST                                                    C       19860101    20080101     20071231


L3835     D      WHFO, ADDITION TO SHORT AND LONG OPPONENS, M.P. SPRING EXTENSION ASSIST                                             C       19860101    20080101     20071231


L3840     D      WHFO, ADDITION TO SHORT AND LONG OPPONENS, SPRING SWIVEL THUMB                                                      C       19860101    20080101     20071231




                                                       Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                               Code Add   Action Eff
HCPCS            Long Description                                                                                                 Coverage                           Term Date
        Code                                                                                                                                   Date       Date


L3845     D      WHFO, ADDITION TO SHORT AND LONG OPPONENS, THUMB I.P. EXTENSION ASSIST, WITH M.P. STOP                              C       19860101    20080101     20071231


L3850     D      WHO, ADDITION TO SHORT AND LONG OPPONENS, ACTION WRIST, WITH DORSIFLEXION ASSIST                                    C       19860101    20080101     20071231


L3855     D      WHFO, ADDITION TO SHORT AND LONG OPPONENS, ADJUSTABLE M.P. FLEXION CONTROL                                          C       19860101    20080101     20071231


L3860     D      WHFO, ADDITION TO SHORT AND LONG OPPONENS, ADJUSTABLE M.P. FLEXION CONTROL AND I.P.                                 C       19860101    20080101     20071231


                 ADDITION TO UPPER EXTREMITY JOINT, WRIST OR ELBOW, CONCENTRIC ADJUSTABLE TORSION STYLE
L3890     D                                                                                                                          C       19950101    19980312     20081231
                 MECHANISM, EACH

                 WRIST HAND FINGER ORTHOSIS, DYNAMIC FLEXOR HINGE, RECIPROCAL WRIST EXTENSION/FLEXION, FINGER
L3900                                                                                                                                C       19860101    20010101
                 FLEXION/EXTENSION, WRIST OR FINGER DRIVEN, CUSTOM-FABRICATED

                 WRIST HAND FINGER ORTHOSIS, DYNAMIC FLEXOR HINGE, RECIPROCAL WRIST EXTENSION/FLEXION, FINGER
L3901                                                                                                                                C       19840101    20010101
                 FLEXION/EXTENSION, CABLE DRIVEN, CUSTOM-FABRICATED


L3902     D      WRIST HAND FINGER ORTHOSIS, EXTERNAL POWERED, COMPRESSED GAS, CUSTOM-FABRICATED                                     I       19850101    20070101     20061231


L3904            WRIST HAND FINGER ORTHOSIS, EXTERNAL POWERED, ELECTRIC, CUSTOM-FABRICATED                                           C       19820101    20010101


                 WRIST HAND ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINTS, ELASTIC BANDS, TURNBUCKLES, MAY
L3905                                                                                                                                C       20060101    20060101
                 INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 WRIST HAND ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED,
L3906                                                                                                                                C       19860101    20060101
                 INCLUDES FITTING AND ADJUSTMENT


L3907     D      WRIST HAND FINGER ORTHOSIS, WRIST GAUNTLET WITH THUMB SPICA, CUSTOM-FABRICATED                                      C       19880101    20080101     20071231


                 WRIST HAND ORTHOSIS, WRIST EXTENSION CONTROL COCK-UP, NON MOLDED, PREFABRICATED, INCLUDES
L3908                                                                                                                                C       19860101    20010101
                 FITTING AND ADJUSTMENT


L3909     D      WRIST ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRENE, LYCRA)                      C       20030101    20030101     20091231


L3910     D      WRIST HAND FINGER ORTHOSIS, SWANSON DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                          C       19820101    20080101     20071231


                 WRIST HAND FINGER ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G.
L3911     D                                                                                                                          C       20030101    20030101     20091231
                 NEOPRENE, LYCRA)

                 HAND FINGER ORTHOSIS, FLEXION GLOVE WITH ELASTIC FINGER CONTROL, PREFABRICATED, INCLUDES
L3912                                                                                                                                C       19820101    20010101
                 FITTING AND ADJUSTMENT

                 HAND FINGER ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED,
L3913                                                                                                                                C       20060101    20060101
                 INCLUDES FITTING AND ADJUSTMENT



                                                       Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date


L3914     D      WRIST HAND ORTHOSIS, WRIST EXTENSION COCK-UP, PREFABRICATED, INCLUDES FITTING/ADJUSTMENT                             C       19860101    20070101     20061231


                 WRIST HAND ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINT(S), ELASTIC BANDS, TURNBUCKLES,
L3915     A                                                                                                                           C       20070101    20070101
                 MAY INCLUDE SOFT INTERFACE, STRAPS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 WRIST HAND FINGER ORTHOSIS, WRIST EXTENSION COCK-UP WITH OUTRIGGER, PREFABRICATED, INCLUDES
L3916     D                                                                                                                           C       19860101    20080101     20071231
                 FITTING AND ADJUSTMENT


L3917            HAND ORTHOSIS, METACARPAL FRACTURE ORTHOSIS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                          C       20040101    20040101


L3918     D      HAND FINGER ORTHOSIS, KNUCKLE BENDER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                 C       19820101    20080101     20071231


                 HAND ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED,
L3919                                                                                                                                 C       20060101    20060101
                 INCLUDES FITTING AND ADJUSTMENT

                 HAND FINGER ORTHOSIS, KNUCKLE BENDER WITH OUTRIGGER, PREFABRICATED, INCLUDES FITTING AND
L3920     D                                                                                                                           C       19820101    20080101     20071231
                 ADJUSTMENT

                 HAND FINGER ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINTS, ELASTIC BANDS, TURNBUCKLES,
L3921                                                                                                                                 C       20060101    20060101
                 MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 HAND FINGER ORTHOSIS, KNUCKLE BENDER, TWO SEGMENT TO FLEX JOINTS, PREFABRICATED, INCLUDES
L3922     D                                                                                                                           C       19820101    20080101     20071231
                 FITTING AND ADJUSTMENT

                 HAND FINGER ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, PREFABRICATED,
L3923                                                                                                                                 C       20010101    20060101
                 INCLUDES FITTING AND ADJUSTMENT


L3924     D      WRIST HAND FINGER ORTHOSIS, OPPENHEIMER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                              C       19820101    20080101     20071231


                 FINGER ORTHOSIS, PROXIMAL INTERPHALANGEAL (PIP)/DISTAL INTERPHALANGEAL (DIP), NON TORSION
L3925     A      JOINT/SPRING, EXTENSION/FLEXION, MAY INCLUDE SOFT INTERFACE MATERIAL, PREFABRICATED, INCLUDES                        C       20080101    20080101
                 FITTING AND ADJUSTMENT

                 WRIST HAND FINGER ORTHOSIS, THOMAS SUSPENSION, PREFABRICATED, INCLUDES FITTING AND
L3926     D                                                                                                                           C       19820101    20080101     20071231
                 ADJUSTMENT

                 FINGER ORTHOSIS, PROXIMAL INTERPHALANGEAL (PIP)/DISTAL INTERPHALANGEAL (DIP), WITHOUT
L3927     A      JOINT/SPRING, EXTENSION/FLEXION (E.G. STATIC OR RING TYPE), MAY INCLUDE SOFT INTERFACE MATERIAL,                     C       20080101    20080101
                 PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 HAND FINGER ORTHOSIS, FINGER EXTENSION, WITH CLOCK SPRING, PREFABRICATED, INCLUDES FITTING AND
L3928     D                                                                                                                           C       19820101    20080101     20071231
                 ADJUSTMENT

                 HAND FINGER ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINT(S), TURNBUCKLES, ELASTIC
L3929     A      BANDS/SPRINGS, MAY INCLUDE SOFT INTERFACE MATERIAL, STRAPS, PREFABRICATED, INCLUDES FITTING                          C       20080101    20080101
                 AND ADJUSTMENT

                 WRIST HAND FINGER ORTHOSIS, FINGER EXTENSION, WITH WRIST SUPPORT, PREFABRICATED, INCLUDES
L3930     D                                                                                                                           C       19820101    20080101     20071231
                 FITTING AND ADJUSTMENT




                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date

                 WRIST HAND FINGER ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINT(S), TURNBUCKLES, ELASTIC
L3931     A      BANDS/SPRINGS, MAY INCLUDE SOFT INTERFACE MATERIAL, STRAPS, PREFABRICATED, INCLUDES FITTING                          C       20080101    20080101
                 AND ADJUSTMENT


L3932     D      FINGER ORTHOSIS, SAFETY PIN, SPRING WIRE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                             C       19820101    20080101     20071231


                 FINGER ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, CUSTOM FABRICATED, INCLUDES
L3933                                                                                                                                 C       20060101    20060101
                 FITTING AND ADJUSTMENT


L3934     D      FINGER ORTHOSIS, SAFETY PIN, MODIFIED, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                C       19820101    20080101     20071231


                 FINGER ORTHOSIS, NONTORSION JOINT, MAY INCLUDE SOFT INTERFACE, CUSTOM FABRICATED, INCLUDES
L3935                                                                                                                                 C       20060101    20060101
                 FITTING AND ADJUSTMENT


L3936     D      WRIST HAND FINGER ORTHOSIS, PALMER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                   C       19820101    20080101     20071231


L3938     D      WRIST HAND FINGER ORTHOSIS, DORSAL WRIST, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                             C       19820101    20080101     20071231


                 WRIST HAND FINGER ORTHOSIS, DORSAL WRIST, WITH OUTRIGGER ATTACHMENT, PREFABRICATED,
L3940     D                                                                                                                           C       19820101    20080101     20071231
                 INCLUDES FITTING AND ADJUSTMENT

                 HAND FINGER ORTHOSIS, REVERSE KNUCKLE BENDER, PREFABRICATED, INCLUDES FITTING AND
L3942     D                                                                                                                           C       19820101    20080101     20071231
                 ADJUSTMENT

                 HAND FINGER ORTHOSIS, REVERSE KNUCKLE BENDER, WITH OUTRIGGER, PREFABRICATED, INCLUDES
L3944     D                                                                                                                           C       19820101    20080101     20071231
                 FITTING AND ADJUSTMENT


L3946     D      HAND FINGER ORTHOSIS, COMPOSITE ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                              C       19820101    20080101     20071231


L3948     D      FINGER ORTHOSIS, FINGER KNUCKLE BENDER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                               C       19820101    20080101     20071231


                 WRIST HAND FINGER ORTHOSIS, COMBINATION OPPENHEIMER, WITH KNUCKLE BENDER AND TWO
L3950     D                                                                                                                           C       19820101    20080101     20071231
                 ATTACHMENTS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 WRIST HAND FINGER ORTHOSIS, COMBINATION OPPENHEIMER, WITH REVERSE KNUCKLE AND TWO
L3952     D                                                                                                                           C       19820101    20080101     20071231
                 ATTACHMENTS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT


L3954     D      HAND FINGER ORTHOSIS, SPREADING HAND, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                 C       19820101    20080101     20071231


L3956     D      ADDITION OF JOINT TO UPPER EXTREMITY ORTHOSIS, ANY MATERIAL; PER JOINT                                               C       19970101    19970101


                 SHOULDER ELBOW WRIST HAND ORTHOSIS, ABDUCTION POSITIONING, AIRPLANE DESIGN, PREFABRICATED,
L3960                                                                                                                                 C       19860101    20010101
                 INCLUDES FITTING AND ADJUSTMENT

                 SHOULDER ELBOW WRIST HAND ORTHOSIS, SHOULDER CAP DESIGN, WITHOUT JOINTS, MAY INCLUDE SOFT
L3961                                                                                                                                 C       20060101    20060101
                 INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT


                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                              Code Add   Action Eff
HCPCS            Long Description                                                                                                Coverage                           Term Date
        Code                                                                                                                                  Date       Date

                 SHOULDER ELBOW WRIST HAND ORTHOSIS, ABDUCTION POSITIONING, ERBS PALSEY DESIGN,
L3962                                                                                                                               C       19820101    20010101
                 PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 SHOULDER ELBOW WRIST HAND ORTHOSIS, MOLDED SHOULDER, ARM, FOREARM AND WRIST, WITH
L3963     D                                                                                                                         C       19880101    20060101     20051231
                 ARTICULATING ELBOW JOINT, CUSTOM-FABRICATED

                 SHOULDER ELBOW ORTHOSIS, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED,
L3964     C                                                                                                                         C       19860101    20120101
                 ADJUSTABLE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 SHOULDER ELBOW ORTHOSIS, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED, ADJUSTABLE
L3965     D                                                                                                                         C       19840101    20010101     20111231
                 RANCHO TYPE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 SHOULDER ELBOW ORTHOSIS, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED, RECLINING,
L3966     D                                                                                                                         C       19860101    20010101     20111231
                 PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 SHOULDER ELBOW WRIST HAND ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN), THORACIC
L3967            COMPONENT AND SUPPORT BAR, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM                              C       20060101    20060101
                 FABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 SHOULDER ELBOW ORTHOSIS, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED, FRICTION
L3968     D      ARM SUPPORT (FRICTION DAMPENING TO PROXIMAL AND DISTAL JOINTS), PREFABRICATED, INCLUDES                            C       19860101    20010101     20111231
                 FITTING AND ADJUSTMENT

                 SHOULDER ELBOW ORTHOSIS, MOBILE ARM SUPPORT, MONOSUSPENSION ARM AND HAND SUPPORT,
L3969     D      OVERHEAD ELBOW FOREARM HAND SLING SUPPORT, YOKE TYPE SUSPENSION SUPPORT, PREFABRICATED,                            C       19880101    20010101     20111231
                 INCLUDES FITTING AND ADJUSTMENT


L3970     D      SEO, ADDITION TO MOBILE ARM SUPPORT, ELEVATING PROXIMAL ARM                                                        C       19860101    19980101     20111231


                 SHOULDER ELBOW WRIST HAND ORTHOSIS, SHOULDER CAP DESIGN, INCLUDES ONE OR MORE NONTORSION
L3971            JOINTS, ELASTIC BANDS, TURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED,                         C       20060101    20060101
                 INCLUDES FITTING AND ADJUSTMENT

                 SEO, ADDITION TO MOBILE ARM SUPPORT, OFFSET OR LATERAL ROCKER ARM WITH ELASTIC BALANCE
L3972     D                                                                                                                         C       19860101    19980101     20111231
                 CONTROL

                 SHOULDER ELBOW WRIST HAND ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN), THORACIC
                 COMPONENT AND SUPPORT BAR, INCLUDES ONE OR MORE NONTORSION JOINTS, ELASTIC BANDS,
L3973                                                                                                                               C       20060101    20060101
                 TURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND
                 ADJUSTMENT


L3974     D      SEO, ADDITION TO MOBILE ARM SUPPORT, SUPINATOR                                                                     C       19860101    19980101     20111231


                 SHOULDER ELBOW WRIST HAND FINGER ORTHOSIS, SHOULDER CAP DESIGN, WITHOUT JOINTS, MAY INCLUDE
L3975                                                                                                                               C       20060101    20060101
                 SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 SHOULDER ELBOW WRIST HAND FINGER ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN), THORACIC
L3976            COMPONENT AND SUPPORT BAR, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM                              C       20060101    20060101
                 FABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 SHOULDER ELBOW WRIST HAND FINGER ORTHOSIS, SHOULDER CAP DESIGN, INCLUDES ONE OR MORE
L3977            NONTORSION JOINTS, ELASTIC BANDS, TURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM                          C       20060101    20060101
                 FABRICATED, INCLUDES FITTING AND ADJUSTMENT



                                                      Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                               Code Add   Action Eff
HCPCS            Long Description                                                                                                 Coverage                           Term Date
        Code                                                                                                                                   Date       Date

                 SHOULDER ELBOW WRIST HAND FINGER ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN), THORACIC
                 COMPONENT AND SUPPORT BAR, INCLUDES ONE OR MORE NONTORSION JOINTS, ELASTIC BANDS,
L3978                                                                                                                                C       20060101    20060101
                 TURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND
                 ADJUSTMENT


L3980            UPPER EXTREMITY FRACTURE ORTHOSIS, HUMERAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                          C       19820101    20010101


                 UPPER EXTREMITY FRACTURE ORTHOSIS, RADIUS/ULNAR, PREFABRICATED, INCLUDES FITTING AND
L3982                                                                                                                                C       19840101    20010101
                 ADJUSTMENT


L3984            UPPER EXTREMITY FRACTURE ORTHOSIS, WRIST, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                            C       19820101    20010101


L3985     D      UPPER EXTREMITY FRACTURE ORTHOSIS, FOREARM, HAND WITH WRIST HINGE, CUSTOM-FABRICATED                                C       19880101    20080101     20071231


                 UPPER EXTREMITY FRACTURE ORTHOSIS, COMBINATION OF HUMERAL, RADIUS/ULNAR, WRIST, (EXAMPLE--
L3986     D                                                                                                                          C       19840101    20080101     20071231
                 COLLES' FRACTURE), CUSTOM FABRICATED


L3995            ADDITION TO UPPER EXTREMITY ORTHOSIS, SOCK, FRACTURE OR EQUAL, EACH                                                 C       19890101    19960101


L3999            UPPER LIMB ORTHOSIS, NOT OTHERWISE SPECIFIED                                                                        C       19820101    19980101


L4000            REPLACE GIRDLE FOR SPINAL ORTHOSIS (CTLSO OR SO)                                                                    C       19850101    20020101


L4002            REPLACEMENT STRAP, ANY ORTHOSIS, INCLUDES ALL COMPONENTS, ANY LENGTH, ANY TYPE                                      C       20050101    20050101


L4010            REPLACE TRILATERAL SOCKET BRIM                                                                                      C       19850101    19960101


L4020            REPLACE QUADRILATERAL SOCKET BRIM, MOLDED TO PATIENT MODEL                                                          C       19850101    19960101


L4030            REPLACE QUADRILATERAL SOCKET BRIM, CUSTOM FITTED                                                                    C       19850101    19960101


L4040            REPLACE MOLDED THIGH LACER, FOR CUSTOM FABRICATED ORTHOSIS ONLY                                                     C       19850101    20050101


L4045            REPLACE NON-MOLDED THIGH LACER, FOR CUSTOM FABRICATED ORTHOSIS ONLY                                                 C       19880101    20050101


L4050            REPLACE MOLDED CALF LACER, FOR CUSTOM FABRICATED ORTHOSIS ONLY                                                      C       19850101    20050101


L4055            REPLACE NON-MOLDED CALF LACER, FOR CUSTOM FABRICATED ORTHOSIS ONLY                                                  C       19880101    20050101




                                                       Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date


L4060            REPLACE HIGH ROLL CUFF                                                                                               C       19850101    19960101


L4070            REPLACE PROXIMAL AND DISTAL UPRIGHT FOR KAFO                                                                         C       19860101    19960101


L4080            REPLACE METAL BANDS KAFO, PROXIMAL THIGH                                                                             C       19860101    19960101


L4090            REPLACE METAL BANDS KAFO-AFO, CALF OR DISTAL THIGH                                                                   C       19850101    19960101


L4100            REPLACE LEATHER CUFF KAFO, PROXIMAL THIGH                                                                            C       19860101    19960101


L4110            REPLACE LEATHER CUFF KAFO-AFO, CALF OR DISTAL THIGH                                                                  C       19850101    19960101


L4130            REPLACE PRETIBIAL SHELL                                                                                              C       19840101    19960101


L4205            REPAIR OF ORTHOTIC DEVICE, LABOR COMPONENT, PER 15 MINUTES                                                           D       19970101    19970101


L4210            REPAIR OF ORTHOTIC DEVICE, REPAIR OR REPLACE MINOR PARTS                                                             D       19850101    19960101


                 ANKLE CONTROL ORTHOSIS, STIRRUP STYLE, RIGID, INCLUDES ANY TYPE INTERFACE (E.G., PNEUMATIC, GEL),
L4350                                                                                                                                 C       19890101    20040101
                 PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 WALKING BOOT, PNEUMATIC AND/OR VACUUM, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE
L4360     C                                                                                                                           C       19890101    20090101
                 MATERIAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT


L4370            PNEUMATIC FULL LEG SPLINT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                            C       19890101    20030101


L4380     D      PNEUMATIC KNEE SPLINT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                C       19890101    20030101     20111231


                 WALKING BOOT, NON-PNEUMATIC, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL,
L4386                                                                                                                                 C       20030101    20040101
                 PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT


L4392            REPLACEMENT, SOFT INTERFACE MATERIAL, STATIC AFO                                                                     C       19970101    20010101


L4394            REPLACE SOFT INTERFACE MATERIAL, FOOT DROP SPLINT                                                                    C       19970101    19970101


                 STATIC OR DYNAMIC ANKLE FOOT ORTHOSIS, INCLUDING SOFT INTERFACE MATERIAL, ADJUSTABLE FOR FIT,
L4396     C      FOR POSITIONING, MAY BE USED FOR MINIMAL AMBULATION, PREFABRICATED, INCLUDES FITTING AND                             C       19970101    20100101
                 ADJUSTMENT

                 FOOT DROP SPLINT, RECUMBENT POSITIONING DEVICE, PREFABRICATED, INCLUDES FITTING AND
L4398                                                                                                                                 C       19970101    20010101
                 ADJUSTMENT


                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date

                 ANKLE FOOT ORTHOSIS, WALKING BOOT TYPE, VARUS/VALGUS CORRECTION, ROCKER BOTTOM, ANTERIOR
L4631            TIBIAL SHELL, SOFT INTERFACE, CUSTOM ARCH SUPPORT, PLASTIC OR OTHER MATERIAL, INCLUDES STRAPS                        C       20110101    20110101
                 AND CLOSURES, CUSTOM FABRICATED


L5000            PARTIAL FOOT, SHOE INSERT WITH LONGITUDINAL ARCH, TOE FILLER                                                         D       19820101    19960101


L5010            PARTIAL FOOT, MOLDED SOCKET, ANKLE HEIGHT, WITH TOE FILLER                                                           D       19820101    19960101


L5020            PARTIAL FOOT, MOLDED SOCKET, TIBIAL TUBERCLE HEIGHT, WITH TOE FILLER                                                 D       19820101    19960101


L5050            ANKLE, SYMES, MOLDED SOCKET, SACH FOOT                                                                               C       19850101    19960101


L5060            ANKLE, SYMES, METAL FRAME, MOLDED LEATHER SOCKET, ARTICULATED ANKLE/FOOT                                             C       19850101    19960101


L5100            BELOW KNEE, MOLDED SOCKET, SHIN, SACH FOOT                                                                           C       19820101    19960101


L5105            BELOW KNEE, PLASTIC SOCKET, JOINTS AND THIGH LACER, SACH FOOT                                                        C       19890101    19960101


L5150            KNEE DISARTICULATION (OR THROUGH KNEE), MOLDED SOCKET, EXTERNAL KNEE JOINTS, SHIN, SACH FOOT                         C       19820101    19960101


                 KNEE DISARTICULATION (OR THROUGH KNEE), MOLDED SOCKET, BENT KNEE CONFIGURATION, EXTERNAL
L5160                                                                                                                                 C       19820101    19960101
                 KNEE JOINTS, SHIN, SACH FOOT


L5200            ABOVE KNEE, MOLDED SOCKET, SINGLE AXIS CONSTANT FRICTION KNEE, SHIN, SACH FOOT                                       C       19820101    19960101


L5210            ABOVE KNEE, SHORT PROSTHESIS, NO KNEE JOINT ('STUBBIES'), WITH FOOT BLOCKS, NO ANKLE JOINTS, EACH                    C       19820101    19960101


                 ABOVE KNEE, SHORT PROSTHESIS, NO KNEE JOINT ('STUBBIES'), WITH ARTICULATED ANKLE/FOOT,
L5220                                                                                                                                 C       19820101    19960101
                 DYNAMICALLY ALIGNED, EACH


L5230            ABOVE KNEE, FOR PROXIMAL FEMORAL FOCAL DEFICIENCY, CONSTANT FRICTION KNEE, SHIN, SACH FOOT                           C       19820101    19960101


                 HIP DISARTICULATION, CANADIAN TYPE; MOLDED SOCKET, HIP JOINT, SINGLE AXIS CONSTANT FRICTION KNEE,
L5250                                                                                                                                 C       19820101    19960101
                 SHIN, SACH FOOT

                 HIP DISARTICULATION, TILT TABLE TYPE; MOLDED SOCKET, LOCKING HIP JOINT, SINGLE AXIS CONSTANT
L5270                                                                                                                                 C       19820101    19960101
                 FRICTION KNEE, SHIN, SACH FOOT

                 HEMIPELVECTOMY, CANADIAN TYPE; MOLDED SOCKET, HIP JOINT, SINGLE AXIS CONSTANT FRICTION KNEE,
L5280                                                                                                                                 C       19820101    19960101
                 SHIN, SACH FOOT


L5301            BELOW KNEE, MOLDED SOCKET, SHIN, SACH FOOT, ENDOSKELETAL SYSTEM                                                      C       20020101    20020101



                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
         Action                                                                                                                                  Code Add   Action Eff
HCPCS             Long Description                                                                                                    Coverage                           Term Date
         Code                                                                                                                                      Date       Date

                  KNEE DISARTICULATION (OR THROUGH KNEE), MOLDED SOCKET, EXTERNAL KNEE JOINTS, SHIN, SACH FOOT,
L5311      D                                                                                                                             C       20020101    20020101     20111231
                  ENDOSKELETAL SYSTEM

                  KNEE DISARTICULATION (OR THROUGH KNEE), MOLDED SOCKET, SINGLE AXIS KNEE, PYLON, SACH FOOT,
 L5312     A                                                                                                                             C       20120101    20120101
                  ENDOSKELETAL SYSTEM


L5321             ABOVE KNEE, MOLDED SOCKET, OPEN END, SACH FOOT, ENDOSKELETAL SYSTEM, SINGLE AXIS KNEE                                  C       20020101    20020101


                  HIP DISARTICULATION, CANADIAN TYPE, MOLDED SOCKET, ENDOSKELETAL SYSTEM, HIP JOINT, SINGLE AXIS
L5331                                                                                                                                    C       20020101    20020101
                  KNEE, SACH FOOT

                  HEMIPELVECTOMY, CANADIAN TYPE, MOLDED SOCKET, ENDOSKELETAL SYSTEM, HIP JOINT, SINGLE AXIS
L5341                                                                                                                                    C       20020101    20020101
                  KNEE, SACH FOOT

                  IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID DRESSING, INCLUDING FITTING,
L5400                                                                                                                                    C       19820101    19960101
                  ALIGNMENT, SUSPENSION, AND ONE CAST CHANGE, BELOW KNEE

                  IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID DRESSING, INCLUDING FITTING,
L5410                                                                                                                                    C       19860101    19960101
                  ALIGNMENT AND SUSPENSION, BELOW KNEE, EACH ADDITIONAL CAST CHANGE AND REALIGNMENT

                  IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID DRESSING, INCLUDING FITTING,
L5420                                                                                                                                    C       19820101    19960101
                  ALIGNMENT AND SUSPENSION AND ONE CAST CHANGE 'AK' OR KNEE DISARTICULATION

                  IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID DRESSING, INCL. FITTING,
L5430             ALIGNMENT AND SUPENSION, 'AK' OR KNEE DISARTICULATION, EACH ADDITIONAL CAST CHANGE AND                                 C       19860101    19960101
                  REALIGNMENT

                  IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF NON-WEIGHT BEARING RIGID DRESSING,
L5450                                                                                                                                    C       19820101    19960101
                  BELOW KNEE

                  IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF NON-WEIGHT BEARING RIGID DRESSING,
L5460                                                                                                                                    C       19820101    19960101
                  ABOVE KNEE

                  INITIAL, BELOW KNEE 'PTB' TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO COVER, SACH FOOT, PLASTER
L5500                                                                                                                                    C       19860101    19960101
                  SOCKET, DIRECT FORMED

                  INITIAL, ABOVE KNEE - KNEE DISARTICULATION, ISCHIAL LEVEL SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO
L5505                                                                                                                                    C       19860101    19960101
                  COVER, SACH FOOT, PLASTER SOCKET, DIRECT FORMED

                  PREPARATORY, BELOW KNEE 'PTB' TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO COVER, SACH FOOT,
L5510                                                                                                                                    C       19860101    19960101
                  PLASTER SOCKET, MOLDED TO MODEL

                  PREPARATORY, BELOW KNEE 'PTB' TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO COVER, SACH FOOT,
L5520                                                                                                                                    C       19860101    19960101
                  THERMOPLASTIC OR EQUAL, DIRECT FORMED

                  PREPARATORY, BELOW KNEE 'PTB' TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO COVER, SACH FOOT,
L5530                                                                                                                                    C       19860101    19960101
                  THERMOPLASTIC OR EQUAL, MOLDED TO MODEL

                  PREPARATORY, BELOW KNEE 'PTB' TYPE SOCKET, NON-ALIGNABLE SYSTEM, NO COVER, SACH FOOT,
L5535                                                                                                                                    C       19890101    19960101
                  PREFABRICATED, ADJUSTABLE OPEN END SOCKET

                  PREPARATORY, BELOW KNEE 'PTB' TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO COVER, SACH FOOT,
L5540                                                                                                                                    C       19860101    19960101
                  LAMINATED SOCKET, MOLDED TO MODEL


                                                           Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                               Code Add   Action Eff
HCPCS            Long Description                                                                                                 Coverage                           Term Date
        Code                                                                                                                                   Date       Date

                 PREPARATORY, ABOVE KNEE- KNEE DISARTICULATION, ISCHIAL LEVEL SOCKET, NON-ALIGNABLE SYSTEM,
L5560                                                                                                                                C       19860101    19960101
                 PYLON, NO COVER, SACH FOOT, PLASTER SOCKET, MOLDED TO MODEL

                 PREPARATORY, ABOVE KNEE - KNEE DISARTICULATION, ISCHIAL LEVEL SOCKET, NON-ALIGNABLE SYSTEM,
L5570                                                                                                                                C       19860101    19960101
                 PYLON, NO COVER, SACH FOOT, THERMOPLASTIC OR EQUAL, DIRECT FORMED

                 PREPARATORY, ABOVE KNEE - KNEE DISARTICULATION ISCHIAL LEVEL SOCKET, NON-ALIGNABLE SYSTEM,
L5580                                                                                                                                C       19860101    19960101
                 PYLON, NO COVER, SACH FOOT, THERMOPLASTIC OR EQUAL, MOLDED TO MODEL

                 PREPARATORY, ABOVE KNEE - KNEE DISARTICULATION, ISCHIAL LEVEL SOCKET, NON-ALIGNABLE SYSTEM,
L5585                                                                                                                                C       19880101    19960101
                 PYLON, NO COVER, SACH FOOT, PREFABRICATED ADJUSTABLE OPEN END SOCKET

                 PREPARATORY, ABOVE KNEE - KNEE DISARTICULATION ISCHIAL LEVEL SOCKET, NON-ALIGNABLE SYSTEM,
L5590                                                                                                                                C       19860101    19960101
                 PYLON NO COVER, SACH FOOT, LAMINATED SOCKET, MOLDED TO MODEL

                 PREPARATORY, HIP DISARTICULATION-HEMIPELVECTOMY, PYLON, NO COVER, SACH FOOT, THERMOPLASTIC
L5595                                                                                                                                C       19890101    19960101
                 OR EQUAL, MOLDED TO PATIENT MODEL

                 PREPARATORY, HIP DISARTICULATION-HEMIPELVECTOMY, PYLON, NO COVER, SACH FOOT, LAMINATED
L5600                                                                                                                                C       19890101    19960101
                 SOCKET, MOLDED TO PATIENT MODEL


L5610            ADDITION TO LOWER EXTREMITY, ENDOSKELETAL SYSTEM, ABOVE KNEE, HYDRACADENCE SYSTEM                                   C       19860101    19960101


                 ADDITION TO LOWER EXTREMITY, ENDOSKELETAL SYSTEM, ABOVE KNEE - KNEE DISARTICULATION, 4 BAR
L5611                                                                                                                                C       19890101    19960101
                 LINKAGE, WITH FRICTION SWING PHASE CONTROL

                 ADDITION TO LOWER EXTREMITY, ENDOSKELETAL SYSTEM, ABOVE KNEE-KNEE DISARTICULATION, 4 BAR
L5613                                                                                                                                C       19890101    19960101
                 LINKAGE, WITH HYDRAULIC SWING PHASE CONTROL

                 ADDITION TO LOWER EXTREMITY, EXOSKELETAL SYSTEM, ABOVE KNEE-KNEE DISARTICULATION, 4 BAR
L5614                                                                                                                                C       19940101    19960101
                 LINKAGE, WITH PNEUMATIC SWING PHASE CONTROL

                 ADDITION TO LOWER EXTREMITY, ENDOSKELETAL SYSTEM, ABOVE KNEE, UNIVERSAL MULTIPLEX SYSTEM,
L5616                                                                                                                                C       19860101    19960101
                 FRICTION SWING PHASE CONTROL


L5617            ADDITION TO LOWER EXTREMITY, QUICK CHANGE SELF-ALIGNING UNIT, ABOVE KNEE OR BELOW KNEE, EACH                        C       19960101    19960101


L5618            ADDITION TO LOWER EXTREMITY, TEST SOCKET, SYMES                                                                     C       19860101    19960101


L5620            ADDITION TO LOWER EXTREMITY, TEST SOCKET, BELOW KNEE                                                                C       19860101    19960101


L5622            ADDITION TO LOWER EXTREMITY, TEST SOCKET, KNEE DISARTICULATION                                                      C       19860101    19960101


L5624            ADDITION TO LOWER EXTREMITY, TEST SOCKET, ABOVE KNEE                                                                C       19860101    19960101


L5626            ADDITION TO LOWER EXTREMITY, TEST SOCKET, HIP DISARTICULATION                                                       C       19860101    19960101




                                                       Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                               Code Add   Action Eff
HCPCS            Long Description                                                                                                 Coverage                           Term Date
        Code                                                                                                                                   Date       Date


L5628            ADDITION TO LOWER EXTREMITY, TEST SOCKET, HEMIPELVECTOMY                                                            C       19860101    19960101


L5629            ADDITION TO LOWER EXTREMITY, BELOW KNEE, ACRYLIC SOCKET                                                             C       19890101    19960101


L5630            ADDITION TO LOWER EXTREMITY, SYMES TYPE, EXPANDABLE WALL SOCKET                                                     C       19860101    19960101


L5631            ADDITION TO LOWER EXTREMITY, ABOVE KNEE OR KNEE DISARTICULATION, ACRYLIC SOCKET                                     C       19890101    19960101


L5632            ADDITION TO LOWER EXTREMITY, SYMES TYPE, 'PTB' BRIM DESIGN SOCKET                                                   C       19860101    19960101


L5634            ADDITION TO LOWER EXTREMITY, SYMES TYPE, POSTERIOR OPENING (CANADIAN) SOCKET                                        C       19860101    19960101


L5636            ADDITION TO LOWER EXTREMITY, SYMES TYPE, MEDIAL OPENING SOCKET                                                      C       19860101    19960101


L5637            ADDITION TO LOWER EXTREMITY, BELOW KNEE, TOTAL CONTACT                                                              C       19890101    19960101


L5638            ADDITION TO LOWER EXTREMITY, BELOW KNEE, LEATHER SOCKET                                                             C       19860101    19960101


L5639            ADDITION TO LOWER EXTREMITY, BELOW KNEE, WOOD SOCKET                                                                C       19890101    19960101


L5640            ADDITION TO LOWER EXTREMITY, KNEE DISARTICULATION, LEATHER SOCKET                                                   C       19860101    19960101


L5642            ADDITION TO LOWER EXTREMITY, ABOVE KNEE, LEATHER SOCKET                                                             C       19860101    19960101


L5643            ADDITION TO LOWER EXTREMITY, HIP DISARTICULATION, FLEXIBLE INNER SOCKET, EXTERNAL FRAME                             C       19880101    19960101


L5644            ADDITION TO LOWER EXTREMITY, ABOVE KNEE, WOOD SOCKET                                                                C       19860101    19960101


L5645            ADDITION TO LOWER EXTREMITY, BELOW KNEE, FLEXIBLE INNER SOCKET, EXTERNAL FRAME                                      C       19880101    20001213


L5646            ADDITION TO LOWER EXTREMITY, BELOW KNEE, AIR, FLUID, GEL OR EQUAL, CUSHION SOCKET                                   C       19860101    20040101


L5647            ADDITION TO LOWER EXTREMITY, BELOW KNEE SUCTION SOCKET                                                              C       19880101    19960101


L5648            ADDITION TO LOWER EXTREMITY, ABOVE KNEE, AIR, FLUID, GEL OR EQUAL, CUSHION SOCKET                                   C       19860101    20040101




                                                       Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date


L5649            ADDITION TO LOWER EXTREMITY, ISCHIAL CONTAINMENT/NARROW M-L SOCKET                                                   C       19880101    19960101


L5650            ADDITIONS TO LOWER EXTREMITY, TOTAL CONTACT, ABOVE KNEE OR KNEE DISARTICULATION SOCKET                               C       19860101    19960101


L5651            ADDITION TO LOWER EXTREMITY, ABOVE KNEE, FLEXIBLE INNER SOCKET, EXTERNAL FRAME                                       C       19880101    19960101


L5652            ADDITION TO LOWER EXTREMITY, SUCTION SUSPENSION, ABOVE KNEE OR KNEE DISARTICULATION SOCKET                           C       19860101    19960101


L5653            ADDITION TO LOWER EXTREMITY, KNEE DISARTICULATION, EXPANDABLE WALL SOCKET                                            C       19860101    19960101


                 ADDITION TO LOWER EXTREMITY, SOCKET INSERT, SYMES, (KEMBLO, PELITE, ALIPLAST, PLASTAZOTE OR
L5654                                                                                                                                 C       19860101    19960101
                 EQUAL)

                 ADDITION TO LOWER EXTREMITY, SOCKET INSERT, BELOW KNEE (KEMBLO, PELITE, AL;IPLAST, PLASTAZOTE
L5655                                                                                                                                 C       19860101    19960101
                 OR EQUAL)

                 ADDITION TO LOWER EXTREMITY, SOCKET INSERT, KNEE DISARTICULATION (KEMBLO, PELITE, ALIPLAST,
L5656                                                                                                                                 C       19860101    19960101
                 PLASTAZOTE OR EQUAL)

                 ADDITION TO LOWER EXTREMITY, SOCKET INSERT, ABOVE KNEE (KEMBLO, PELITE, ALIPLAST, PLASTAZOTE OR
L5658                                                                                                                                 C       19860101    19960101
                 EQUAL)


L5661            ADDITION TO LOWER EXTREMITY, SOCKET INSERT, MULTI-DUROMETER SYMES                                                    C       19880101    19960101


L5665            ADDITION TO LOWER EXTREMITY, SOCKET INSERT, MULTI-DUROMETER, BELOW KNEE                                              C       19880101    19960101


L5666            ADDITION TO LOWER EXTREMITY, BELOW KNEE, CUFF SUSPENSION                                                             C       19860101    19960101


L5668            ADDITION TO LOWER EXTREMITY, BELOW KNEE, MOLDED DISTAL CUSHION                                                       C       19860101    19960101


L5670            ADDITION TO LOWER EXTREMITY, BELOW KNEE, MOLDED SUPRACONDYLAR SUSPENSION ('PTS' OR SIMILAR)                          C       19860101    19960101


                 ADDITION TO LOWER EXTREMITY, BELOW KNEE / ABOVE KNEE SUSPENSION LOCKING MECHANISM (SHUTTLE,
L5671                                                                                                                                 C       20020101    20020101
                 LANYARD OR EQUAL), EXCLUDES SOCKET INSERT


L5672            ADDITION TO LOWER EXTREMITY, BELOW KNEE, REMOVABLE MEDIAL BRIM SUSPENSION                                            C       19860101    19960101


                 ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED FROM EXISTING MOLD OR
L5673            PREFABRICATED, SOCKET INSERT, SILICONE GEL, ELASTOMERIC OR EQUAL, FOR USE WITH LOCKING                               C       20040101    20040101
                 MECHANISM


L5674     D      ADDITION TO LOWER EXTREMITY, BELOW KNEE, SUSPENSION SLEEVE, ANY MATERIAL, EACH                                       C       19860101    20050101     20041231



                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date


L5675     D      ADDITION TO LOWER EXTREMITY, BELOW KNEE, SUSPENSION SLEEVE, HEAVY DUTY, ANY MATERIAL, EACH                           C       19880101    20050101     20041231


L5676            ADDITIONS TO LOWER EXTREMITY, BELOW KNEE, KNEE JOINTS, SINGLE AXIS, PAIR                                             C       19860101    19960101


L5677            ADDITIONS TO LOWER EXTREMITY, BELOW KNEE, KNEE JOINTS, POLYCENTRIC, PAIR                                             C       19880101    19960101


L5678            ADDITIONS TO LOWER EXTREMITY, BELOW KNEE, JOINT COVERS, PAIR                                                         C       19840101    19960101


                 ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED FROM EXISTING MOLD OR
L5679            PREFABRICATED, SOCKET INSERT, SILICONE GEL, ELASTOMERIC OR EQUAL, NOT FOR USE WITH LOCKING                           C       20040101    20040101
                 MECHANISM


L5680            ADDITION TO LOWER EXTREMITY, BELOW KNEE, THIGH LACER, NONMOLDED                                                      C       19860101    19960101


                 ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED SOCKET INSERT FOR
L5681            CONGENITAL OR ATYPICAL TRAUMATIC AMPUTEE, SILICONE GEL, ELASTOMERIC OR EQUAL, FOR USE WITH OR                        C       20040101    20040101
                 WITHOUT LOCKING MECHANISM, INITIAL ONLY (FOR OTHER THAN INITIAL, USE CODE L5673 OR L5679)


L5682            ADDITION TO LOWER EXTREMITY, BELOW KNEE, THIGH LACER, GLUTEAL/ISCHIAL, MOLDED                                        C       19860101    19960101


                 ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED SOCKET INSERT FOR
                 OTHER THAN CONGENITAL OR ATYPICAL TRAUMATIC AMPUTEE, SILICONE GEL, ELASTOMERIC OR EQUAL, FOR
L5683                                                                                                                                 C       20040101    20040101
                 USE WITH OR WITHOUT LOCKING MECHANISM, INITIAL ONLY (FOR OTHER THAN INITIAL, USE CODE L5673 OR
                 L5679)


L5684            ADDITION TO LOWER EXTREMITY, BELOW KNEE, FORK STRAP                                                                  C       19860101    19960101


                 ADDITION TO LOWER EXTREMITY PROSTHESIS, BELOW KNEE, SUSPENSION/SEALING SLEEVE, WITH OR
L5685                                                                                                                                 C       20050101    20050101
                 WITHOUT VALVE, ANY MATERIAL, EACH

                 ADDITION TO LOWER EXTREMITY, BELOW KNEE, BACK CHECK (EXTENSION CONTROL) ADDITION TO LOWER
L5686                                                                                                                                 C       19860101    19960101
                 EXTREMITY, BELOW KNEE, WAIST BELT, WEBBING


L5690            ADDITION TO LOWER EXTREMITY, BELOW KNEE, WAIST BELT, PADDED AND LINED                                                C       19860101    19960101


L5692            ADDITION TO LOWER EXTREMITY, ABOVE KNEE, PELVIC CONTROL BELT, LIGHT                                                  C       19860101    19960101


L5694            ADDITION TO LOWER EXTREMITY, ABOVE KNEE, PELVIC CONTROL BELT, PADDED AND LINED                                       C       19860101    19960101


                 ADDITION TO LOWER EXTREMITY, ABOVE KNEE, PELVIC CONTROL, SLEEVE SUSPENSION, NEOPRENE OR
L5695                                                                                                                                 C       19890101    19960101
                 EQUAL, EACH


L5696            ADDITION TO LOWER EXTREMITY, ABOVE KNEE OR KNEE DISARTICULATION, PELVIC JOINT                                        C       19860101    19960101



                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                               Code Add   Action Eff
HCPCS            Long Description                                                                                                 Coverage                           Term Date
        Code                                                                                                                                   Date       Date


L5697            ADDITION TO LOWER EXTREMITY, ABOVE KNEE OR KNEE DISARTICULATION, PELVIC BAND                                        C       19860101    19960101


L5698            ADDITION TO LOWER EXTREMITY, ABOVE KNEE OR KNEE DISARTICULATION, SILESIAN BANDAGE                                   C       19860101    19960101


L5699            ALL LOWER EXTREMITY PROSTHESES, SHOULDER HARNESS                                                                    C       19860101    19960101


L5700            REPLACEMENT, SOCKET, BELOW KNEE, MOLDED TO PATIENT MODEL                                                            C       19940101    19940101


                 REPLACEMENT, SOCKET, ABOVE KNEE/KNEE DISARTICULATION, INCLUDING ATTACHMENT PLATE, MOLDED TO
L5701                                                                                                                                C       19940101    19940101
                 PATIENT MODEL


L5702            REPLACEMENT, SOCKET, HIP DISARTICULATION, INCLUDING HIP JOINT, MOLDED TO PATIENT MODEL                              C       19940101    19940101


                 ANKLE, SYMES, MOLDED TO PATIENT MODEL, SOCKET WITHOUT SOLID ANKLE CUSHION HEEL (SACH) FOOT,
L5703                                                                                                                                C       20060101    20060101
                 REPLACEMENT ONLY


L5704            CUSTOM SHAPED PROTECTIVE COVER, BELOW KNEE                                                                          C       19940101    20020101


L5705            CUSTOM SHAPED PROTECTIVE COVER, ABOVE KNEE                                                                          C       19940101    20020101


L5706            CUSTOM SHAPED PROTECTIVE COVER, KNEE DISARTICULATION                                                                C       19940101    20020101


L5707            CUSTOM SHAPED PROTECTIVE COVER, HIP DISARTICULATION                                                                 C       19940101    20020101


L5710            ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, MANUAL LOCK                                                    C       19860101    19960101


L5711            ADDITIONS EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, MANUAL LOCK, ULTRA-LIGHT MATERIAL                              C       19880101    19960101


                 ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FRICTION SWING AND STANCE PHASE CONTROL
L5712                                                                                                                                C       19860101    19960101
                 (SAFETY KNEE)


L5714            ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, VARIABLE FRICTION SWING PHASE CONTROL                          C       19860101    19960101


L5716            ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, MECHANICAL STANCE PHASE LOCK                                   C       19860101    19960101


                 ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, FRICTION SWING AND STANCE PHASE
L5718                                                                                                                                C       19860101    19960101
                 CONTROL

                 ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, PNEUMATIC SWING, FRICTION STANCE PHASE
L5722                                                                                                                                C       19860101    19960101
                 CONTROL



                                                       Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date


L5724            ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING PHASE CONTROL                                       C       19860101    19960101


L5726            ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, EXTERNAL JOINTS FLUID SWING PHASE CONTROL                       C       19860101    19960101


L5728            ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING AND STANCE PHASE CONTROL                            C       19860101    19960101


                 ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, PNEUMATIC/HYDRA PNEUMATIC SWING PHASE
L5780                                                                                                                                 C       19860101    19960101
                 CONTROL

                 ADDITION TO LOWER LIMB PROSTHESIS, VACUUM PUMP, RESIDUAL LIMB VOLUME MANAGEMENT AND
L5781                                                                                                                                 C       20030101    20030101
                 MOISTURE EVACUATION SYSTEM

                 ADDITION TO LOWER LIMB PROSTHESIS, VACUUM PUMP, RESIDUAL LIMB VOLUME MANAGEMENT AND
L5782                                                                                                                                 C       20030101    20030101
                 MOISTURE EVACUATION SYSTEM, HEAVY DUTY

                 ADDITION, EXOSKELETAL SYSTEM, BELOW KNEE, ULTRA-LIGHT MATERIAL (TITANIUM, CARBON FIBER OR
L5785                                                                                                                                 C       19880101    19960101
                 EQUAL)

                 ADDITION, EXOSKELETAL SYSTEM, ABOVE KNEE, ULTRA-LIGHT MATERIAL (TITANIUM, CARBON FIBER OR
L5790                                                                                                                                 C       19880101    19960101
                 EQUAL)

                 ADDITION, EXOSKELETAL SYSTEM, HIP DISARTICULATION, ULTRA-LIGHT MATERIAL (TITANIUM, CARBON FIBER
L5795                                                                                                                                 C       19880101    19960101
                 OR EQUAL)


L5810            ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, MANUAL LOCK                                                    C       19880101    19960101


L5811            ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, MANUAL LOCK, ULTRA-LIGHT MATERIAL                              C       19880101    19960101


                 ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FRICTION SWING AND STANCE PHASE CONTROL
L5812                                                                                                                                 C       19880101    19960101
                 (SAFETY KNEE)

                 ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, HYDRAULIC SWING PHASE CONTROL,
L5814                                                                                                                                 C       19970101    19970101
                 MECHANICAL STANCE PHASE LOCK


L5816            ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, MECHANICAL STANCE PHASE LOCK                                   C       19880101    19960101


                 ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, FRICTION SWING, AND STANCE PHASE
L5818                                                                                                                                 C       19880101    19960101
                 CONTROL

                 ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, PNEUMATIC SWING, FRICTION STANCE PHASE
L5822                                                                                                                                 C       19880101    19960101
                 CONTROL


L5824            ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING PHASE CONTROL                                      C       19880101    19960101


                 ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, HYDRAULIC SWING PHASE CONTROL, WITH
L5826                                                                                                                                 C       19980101    19990101
                 MINIATURE HIGH ACTIVITY FRAME



                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                               Code Add   Action Eff
HCPCS            Long Description                                                                                                 Coverage                           Term Date
        Code                                                                                                                                   Date       Date


L5828            ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING AND STANCE PHASE CONTROL                          C       19880101    19960101


L5830            ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, PNEUMATIC/ SWING PHASE CONTROL                                C       19880101    19960101


                 ADDITION, ENDOSKELETAL KNEE/SHIN SYSTEM, 4-BAR LINKAGE OR MULTIAXIAL, PNEUMATIC SWING PHASE
L5840                                                                                                                                C       19940101    19990101
                 CONTROL


L5845            ADDITION, ENDOSKELETAL, KNEE-SHIN SYSTEM, STANCE FLEXION FEATURE, ADJUSTABLE                                        C       19960101    19960101


L5846     D      ADDITION, ENDOSKELETAL, KNEE-SHIN SYSTEM, MICROPROCESSOR CONTROL FEATURE, SWING PHASE ONLY                          C       19960101    20050101     20041231


L5847     D      ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, MICROPROCESSOR CONTROL FEATURE, STANCE PHASE                               C       20020101    20050101     20041231


                 ADDITION TO ENDOSKELETAL, KNEE-SHIN SYSTEM, FLUID STANCE EXTENSION, DAMPENING FEATURE, WITH
L5848     C                                                                                                                          C       20030101    20070101
                 OR WITHOUT ADJUSTABILITY


L5850            ADDITION, ENDOSKELETAL SYSTEM, ABOVE KNEE OR HIP DISARTICULATION, KNEE EXTENSION ASSIST                             C       19880101    19960101


L5855            ADDITION, ENDOSKELETAL SYSTEM, HIP DISARTICULATION, MECHANICAL HIP EXTENSION ASSIST                                 C       19940101    19950101


                 ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL KNEE-SHIN SYSTEM, MICROPROCESSOR
L5856                                                                                                                                C       20050101    20050101
                 CONTROL FEATURE, SWING AND STANCE PHASE, INCLUDES ELECTRONIC SENSOR(S), ANY TYPE

                 ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL KNEE-SHIN SYSTEM, MICROPROCESSOR
L5857                                                                                                                                C       20050101    20050101
                 CONTROL FEATURE, SWING PHASE ONLY, INCLUDES ELECTRONIC SENSOR(S), ANY TYPE

                 ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL KNEE SHIN SYSTEM, MICROPROCESSOR
L5858                                                                                                                                C       20060101    20060101
                 CONTROL FEATURE, STANCE PHASE ONLY, INCLUDES ELECTRONIC SENSOR(S), ANY TYPE


L5910            ADDITION, ENDOSKELETAL SYSTEM, BELOW KNEE, ALIGNABLE SYSTEM                                                         C       19880101    19960101


L5920            ADDITION, ENDOSKELETAL SYSTEM, ABOVE KNEE OR HIP DISARTICULATION, ALIGNABLE SYSTEM                                  C       19880101    19960101


                 ADDITION, ENDOSKELETAL SYSTEM, ABOVE KNEE, KNEE DISARTICULATION OR HIP DISARTICULATION, MANUAL
L5925                                                                                                                                C       19940101    20000101
                 LOCK


L5930            ADDITION, ENDOSKELETAL SYSTEM, HIGH ACTIVITY KNEE CONTROL FRAME                                                     C       19960101    19960101


                 ADDITION, ENDOSKELETAL SYSTEM, BELOW KNEE, ULTRA-LIGHT MATERIAL (TITANIUM, CARBON FIBER OR
L5940                                                                                                                                C       19880101    19960101
                 EQUAL)

                 ADDITION, ENDOSKELETAL SYSTEM, ABOVE KNEE, ULTRA-LIGHT MATERIAL (TITANIUM, CARBON FIBER OR
L5950                                                                                                                                C       19880101    19960101
                 EQUAL)



                                                       Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date

                 ADDITION, ENDOSKELETAL SYSTEM, HIP DISARTICULATION, ULTRA-LIGHT MATERIAL (TITANIUM, CARBON FIBER
L5960                                                                                                                                 C       19880101    19960101
                 OR EQUAL)

                 ADDITION, ENDOSKELETAL SYSTEM, POLYCENTRIC HIP JOINT, PNEUMATIC OR HYDRAULICCONTROL,
L5961                                                                                                                                 C       20110101    20110101
                 ROTATION CONTROL, WITH OR WITHOUT FLEXION AND/OR EXTENSION CONTROL

                 ADDITION, ENDOSKELETAL SYSTEM, BELOW KNEE, FLEXIBLE PROTECTIVE OUTER SURFACE COVERING
L5962                                                                                                                                 C       19940101    19940101
                 SYSTEM

                 ADDITION, ENDOSKELETAL SYSTEM, ABOVE KNEE, FLEXIBLE PROTECTIVE OUTER SURFACE COVERING
L5964                                                                                                                                 C       19940101    19940101
                 SYSTEM

                 ADDITION, ENDOSKELETAL SYSTEM, HIP DISARTICULATION, FLEXIBLE PROTECTIVE OUTER SURFACE
L5966                                                                                                                                 C       19940101    19940101
                 COVERING SYSTEM

                 ADDITION TO LOWER LIMB PROSTHESIS, MULTIAXIAL ANKLE WITH SWING PHASE ACTIVE DORSIFLEXION
L5968                                                                                                                                 C       19990101    20000101
                 FEATURE


L5970            ALL LOWER EXTREMITY PROSTHESES, FOOT, EXTERNAL KEEL, SACH FOOT                                                       C       19890101    19960101


L5971            ALL LOWER EXTREMITY PROSTHESIS, SOLID ANKLE CUSHION HEEL (SACH) FOOT, REPLACEMENT ONLY                               C       20060101    20060101


L5972            ALL LOWER EXTREMITY PROSTHESES, FLEXIBLE KEEL FOOT (SAFE, STEN, BOCK DYNAMIC OR EQUAL)                               C       19890101    19960101


                 ENDOSKELETAL ANKLE FOOT SYSTEM, MICROPROCESSOR CONTROLLED FEATURE, DORSIFLEXION AND/OR
L5973     A                                                                                                                           C       20100101    20100101
                 PLANTAR FLEXION CONTROL, INCLUDES POWER SOURCE


L5974            ALL LOWER EXTREMITY PROSTHESES, FOOT, SINGLE AXIS ANKLE/FOOT                                                         C       19890101    19960101


L5975            ALL LOWER EXTREMITY PROSTHESIS, COMBINATION SINGLE AXIS ANKLE AND FLEXIBLE KEEL FOOT                                 C       19990101    19990101


L5976            ALL LOWER EXTREMITY PROSTHESES, ENERGY STORING FOOT (SEATTLE CARBON COPY II OR EQUAL)                                C       19890101    19960101


L5978            ALL LOWER EXTREMITY PROSTHESES, FOOT, MULTIAXIAL ANKLE/FOOT                                                          C       19890101    19960101


L5979            ALL LOWER EXTREMITY PROSTHESIS, MULTI-AXIAL ANKLE, DYNAMIC RESPONSE FOOT, ONE PIECE SYSTEM                           C       19940101    20010101


L5980            ALL LOWER EXTREMITY PROSTHESES, FLEX FOOT SYSTEM                                                                     C       19890101    19960101


L5981            ALL LOWER EXTREMITY PROSTHESES, FLEX-WALK SYSTEM OR EQUAL                                                            C       19940101    19940101


L5982            ALL EXOSKELETAL LOWER EXTREMITY PROSTHESES, AXIAL ROTATION UNIT                                                      C       19890101    19960101




                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                               Code Add   Action Eff
HCPCS            Long Description                                                                                                 Coverage                           Term Date
        Code                                                                                                                                   Date       Date

                 ALL ENDOSKELETAL LOWER EXTREMITY PROSTHESIS, AXIAL ROTATION UNIT, WITH OR WITHOUT
L5984                                                                                                                                C       19890101    20040101
                 ADJUSTABILITY


L5985            ALL ENDOSKELETAL LOWER EXTREMITY PROSTHESES, DYNAMIC PROSTHETIC PYLON                                               C       19960101    19960101


L5986            ALL LOWER EXTREMITY PROSTHESES, MULTI-AXIAL ROTATION UNIT ('MCP' OR EQUAL)                                          C       19890101    19960101


L5987            ALL LOWER EXTREMITY PROSTHESIS, SHANK FOOT SYSTEM WITH VERTICAL LOADING PYLON                                       C       19970101    19970101


L5988            ADDITION TO LOWER LIMB PROSTHESIS, VERTICAL SHOCK REDUCING PYLON FEATURE                                            C       19990101    20000101


                 ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL SYSTEM, PYLON WITH INTEGRATED
L5989     D                                                                                                                          C       20020101    20050101     20041231
                 ELECTRONIC FORCE SENSORS


L5990            ADDITION TO LOWER EXTREMITY PROSTHESIS, USER ADJUSTABLE HEEL HEIGHT                                                 C       20020101    20020101


                 ADDITION TO LOWER EXTREMITY PROSTHESIS, HEAVY DUTY FEATURE, FOOT ONLY, (FOR PATIENT WEIGHT
L5993     D                                                                                                                          C       20070101    20070101     20081231
                 GREATER THAN 300 LBS)

                 ADDITION TO LOWER EXTREMITY PROSTHESIS, HEAVY DUTY FEATURE, KNEE ONLY, (FOR PATIENT WEIGHT
L5994     D                                                                                                                          C       20070101    20070101     20081231
                 GREATER THAN 300 LBS)

                 ADDITION TO LOWER EXTREMITY PROSTHESIS, HEAVY DUTY FEATURE, OTHER THAN FOOT OR KNEE, (FOR
L5995     D                                                                                                                          C       20030101    20070101     20081231
                 PATIENT WEIGHT GREATER THAN 300 LBS)


L5999            LOWER EXTREMITY PROSTHESIS, NOT OTHERWISE SPECIFIED                                                                 C       19820101    19980101


L6000     C      PARTIAL HAND, THUMB REMAINING                                                                                       C       19820101    20120101


L6010     C      PARTIAL HAND, LITTLE AND/OR RING FINGER REMAINING                                                                   C       19820101    20120101


L6020     C      PARTIAL HAND, NO FINGER REMAINING                                                                                   C       19820101    20120101


                 TRANSCARPAL/METACARPAL OR PARTIAL HAND DISARTICULATION PROSTHESIS, EXTERNAL POWER, SELF-
L6025            SUSPENDED, INNER SOCKET WITH REMOVABLE FOREARM SECTION, ELECTRODES AND CABLES, TWO                                  C       20030101    20030101
                 BATTERIES, CHARGER, MYOELECTRIC CONTROL OF TERMINAL DEVICE


L6050            WRIST DISARTICULATION, MOLDED SOCKET, FLEXIBLE ELBOW HINGES, TRICEPS PAD                                            C       19820101    19960101


                 WRIST DISARTICULATION, MOLDED SOCKET WITH EXPANDABLE INTERFACE, FLEXIBLE ELBOW HINGES,
L6055                                                                                                                                C       19880101    19960101
                 TRICEPS PAD


L6100            BELOW ELBOW, MOLDED SOCKET, FLEXIBLE ELBOW HINGE, TRICEPS PAD                                                       C       19820101    19960101



                                                       Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                 Code Add   Action Eff
HCPCS            Long Description                                                                                                   Coverage                           Term Date
        Code                                                                                                                                     Date       Date


L6110            BELOW ELBOW, MOLDED SOCKET, (MUENSTER OR NORTHWESTERN SUSPENSION TYPES)                                               C       19820101    19960101


L6120            BELOW ELBOW, MOLDED DOUBLE WALL SPLIT SOCKET, STEP-UP HINGES, HALF CUFF                                               C       19820101    19960101


L6130            BELOW ELBOW, MOLDED DOUBLE WALL SPLIT SOCKET, STUMP ACTIVATED LOCKING HINGE, HALF CUFF                                C       19820101    19960101


L6200            ELBOW DISARTICULATION, MOLDED SOCKET, OUTSIDE LOCKING HINGE, FOREARM                                                  C       19820101    19960101


                 ELBOW DISARTICULATION, MOLDED SOCKET WITH EXPANDABLE INTERFACE, OUTSIDE LOCKING HINGES,
L6205                                                                                                                                  C       19880101    19960101
                 FOREARM


L6250            ABOVE ELBOW, MOLDED DOUBLE WALL SOCKET, INTERNAL LOCKING ELBOW, FOREARM                                               C       19820101    19960101


                 SHOULDER DISARTICULATION, MOLDED SOCKET, SHOULDER BULKHEAD, HUMERAL SECTION, INTERNAL
L6300                                                                                                                                  C       19820101    19960101
                 LOCKING ELBOW, FOREARM


L6310            SHOULDER DISARTICULATION, PASSIVE RESTORATION (COMPLETE PROSTHESIS)                                                   C       19820101    19960101


L6320            SHOULDER DISARTICULATION, PASSIVE RESTORATION (SHOULDER CAP ONLY)                                                     C       19820101    19960101


                 INTERSCAPULAR THORACIC, MOLDED SOCKET, SHOULDER BULKHEAD, HUMERAL SECTION, INTERNAL
L6350                                                                                                                                  C       19840101    19960101
                 LOCKING ELBOW, FOREARM


L6360            INTERSCAPULAR THORACIC, PASSIVE RESTORATION (COMPLETE PROSTHESIS)                                                     C       19860101    19960101


L6370            INTERSCAPULAR THORACIC, PASSIVE RESTORATION (SHOULDER CAP ONLY)                                                       C       19860101    19960101


                 IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID DRESSING, INCLUDING FITTING
L6380            ALIGNMENT AND SUSPENSION OF COMPONENTS, AND ONE CAST CHANGE, WRIST DISARTICULATION OR                                 C       19880101    19960101
                 BELOW ELBOW

                 IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID DRESSING INCLUDING FITTING
L6382            ALIGNMENT AND SUSPENSION OF COMPONENTS, AND ONE CAST CHANGE, ELBOW DISARTICULATION OR                                 C       19880101    19960101
                 ABOVE ELBOW

                 IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID DRESSING INCLUDING FITTING
L6384            ALIGNMENT AND SUSPENSION OF COMPONENTS, AND ONE CAST CHANGE, SHOULDER DISARTICULATION OR                              C       19880101    19960101
                 INTERSCAPULAR THORACIC


L6386            IMMEDIATE POST SURGICAL OR EARLY FITTING, EACH ADDITIONAL CAST CHANGE AND REALIGNMENT                                 C       19880101    19960101


L6388            IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF RIGID DRESSING ONLY                                          C       19880101    19960101




                                                         Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date


L6400            BELOW ELBOW, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT PROSTHETIC TISSUE SHAPING                            C       19820101    19960101


                 ELBOW DISARTICULATION, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT PROSTHETIC TISSUE
L6450                                                                                                                                 C       19820101    19960101
                 SHAPING


L6500            ABOVE ELBOW, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT PROSTHETIC TISSUE SHAPING                            C       19820101    19960101


                 SHOULDER DISARTICULATION, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT PROSTHETIC
L6550                                                                                                                                 C       19840101    19960101
                 TISSUE SHAPING

                 INTERSCAPULAR THORACIC, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT PROSTHETIC
L6570                                                                                                                                 C       19840101    19960101
                 TISSUE SHAPING

                 PREPARATORY, WRIST DISARTICULATION OR BELOW ELBOW, SINGLE WALL PLASTIC SOCKET, FRICTION
L6580            WRIST, FLEXIBLE ELBOW HINGES, FIGURE OF EIGHT HARNESS, HUMERAL CUFF, BOWDEN CABLE CONTROL,                           C       19880101    19960101
                 USMC OR EQUAL PYLON, NO COVER, MOLDED TO PATIENT MODEL

                 PREPARATORY, WRIST DISARTICULATION OR BELOW ELBOW, SINGLE WALL SOCKET, FRICTION WRIST,
L6582            FLEXIBLE ELBOW HINGES, FIGURE OF EIGHT HARNESS, HUMERAL CUFF, BOWDEN CABLE CONTROL, USMC OR                          C       19880101    19960101
                 EQUAL PYLON, NO COVER, DIRECT FORMED

                 PREPARATORY, ELBOW DISARTICULATION OR ABOVE ELBOW, SINGLE WALL PLASTIC SOCKET, FRICTION
L6584            WRIST, LOCKING ELBOW, FIGURE OF EIGHT HARNESS, FAIR LEAD CABLE CONTROL, USMC OR EQUAL PYLON,                         C       19880101    19960101
                 NO COVER, MOLDED TO PATIENT MODEL

                 PREPARATORY, ELBOW DISARTICULATION OR ABOVE ELBOW, SINGLE WALL SOCKET, FRICTION WRIST,
                 LOCKING ELBOW, FIGURE OF EIGHT HARNESS, FAIR LEAD CABLE CONTROL, USMC OR EQUAL PYLON, NO
L6586                                                                                                                                 C       19880101    19960101
                 COVER, DIRECT FORMED WRIST, LOCKING ELBOW, FIGURE OF EIGHT HARNESS, FAIR LEAD CABLE CONTROL,
                 USMC OR EQUAL PYLON, NO COVER, DIRECT FORMED EQUAL PYLON, NO COVER, DIRECT FORMED

                 PREPARATORY, SHOULDER DISARTICULATION OR INTERSCAPULAR THORACIC, SINGLE WALL PLASTIC
L6588            SOCKET, SHOULDER JOINT, LOCKING ELBOW, FRICTION WRIST, CHEST STRAP, FAIR LEAD CABLE CONTROL,                         C       19880101    19960101
                 USMC OR EQUAL PYLON, NO COVER, MOLDED TO PATIENT MODEL

                 PREPARATORY, SHOULDER DISARTICULATION OR INTERSCAPULAR THORACIC, SINGLE WALL SOCKET,
L6590            SHOULDER JOINT, LOCKING ELBOW, FRICTION WRIST, CHEST STRAP, FAIR LEAD CABLE CONTROL, USMC OR                         C       19880101    19960101
                 EQUAL PYLON, NO COVER, DIRECT FORMED


L6600            UPPER EXTREMITY ADDITIONS, POLYCENTRIC HINGE, PAIR                                                                   C       19820101    19960101


L6605            UPPER EXTREMITY ADDITIONS, SINGLE PIVOT HINGE, PAIR                                                                  C       19820101    19960101


L6610            UPPER EXTREMITY ADDITIONS, FLEXIBLE METAL HINGE, PAIR                                                                C       19820101    19960101


L6611     A      ADDITION TO UPPER EXTREMITY PROSTHESIS, EXTERNAL POWERED, ADDITIONAL SWITCH, ANY TYPE                                C       20070101    20070101


L6615            UPPER EXTREMITY ADDITION, DISCONNECT LOCKING WRIST UNIT                                                              C       19860101    19960101




                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                               Code Add   Action Eff
HCPCS            Long Description                                                                                                 Coverage                           Term Date
        Code                                                                                                                                   Date       Date


L6616            UPPER EXTREMITY ADDITION, ADDITIONAL DISCONNECT INSERT FOR LOCKING WRIST UNIT, EACH                                 C       19890101    19960101


L6620            UPPER EXTREMITY ADDITION, FLEXION/EXTENSION WRIST UNIT, WITH OR WITHOUT FRICTION                                    C       19860101    20040101


                 UPPER EXTREMITY PROSTHESIS ADDITION, FLEXION/EXTENSION WRIST WITH OR WITHOUT FRICTION, FOR USE
L6621                                                                                                                                C       20060101    20060101
                 WITH EXTERNAL POWERED TERMINAL DEVICE


L6623            UPPER EXTREMITY ADDITION, SPRING ASSISTED ROTATIONAL WRIST UNIT WITH LATCH RELEASE                                  C       19880101    19960101


L6624     A      UPPER EXTREMITY ADDITION, FLEXION/EXTENSION AND ROTATION WRIST UNIT                                                 C       20070101    20070101


L6625            UPPER EXTREMITY ADDITION, ROTATION WRIST UNIT WITH CABLE LOCK                                                       C       19860101    19960101


L6628            UPPER EXTREMITY ADDITION, QUICK DISCONNECT HOOK ADAPTER, OTTO BOCK OR EQUAL                                         C       19880101    19960101


                 UPPER EXTREMITY ADDITION, QUICK DISCONNECT LAMINATION COLLAR WITH COUPLING PIECE, OTTO BOCK
L6629                                                                                                                                C       19880101    19960101
                 OR EQUAL


L6630            UPPER EXTREMITY ADDITION, STAINLESS STEEL, ANY WRIST                                                                C       19860101    19960101


L6632            UPPER EXTREMITY ADDITION, LATEX SUSPENSION SLEEVE, EACH                                                             C       19880101    19960101


L6635            UPPER EXTREMITY ADDITION, LIFT ASSIST FOR ELBOW                                                                     C       19860101    19960101


L6637            UPPER EXTREMITY ADDITION, NUDGE CONTROL ELBOW LOCK                                                                  C       19880101    19960101


                 UPPER EXTREMITY ADDITION TO PROSTHESIS, ELECTRIC LOCKING FEATURE, ONLY FOR USE WITH MANUALLY
L6638                                                                                                                                C       20030101    20030101
                 POWERED ELBOW


L6639     D      UPPER EXTREMITY ADDITION, HEAVY DUTY FEATURE, ANY ELBOW                                                             C       20070101    20070101     20091231


L6640            UPPER EXTREMITY ADDITIONS, SHOULDER ABDUCTION JOINT, PAIR                                                           C       19820101    19960101


L6641            UPPER EXTREMITY ADDITION, EXCURSION AMPLIFIER, PULLEY TYPE                                                          C       19880101    19960101


L6642            UPPER EXTREMITY ADDITION, EXCURSION AMPLIFIER, LEVER TYPE                                                           C       19880101    19960101


L6645            UPPER EXTREMITY ADDITION, SHOULDER FLEXION-ABDUCTION JOINT, EACH                                                    C       19860101    19960101




                                                       Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date

                 UPPER EXTREMITY ADDITION, SHOULDER JOINT, MULTIPOSITIONAL LOCKING, FLEXION, ADJUSTABLE
L6646                                                                                                                                 C       20030101    20030101
                 ABDUCTION FRICTION CONTROL, FOR USE WITH BODY POWERED OR EXTERNAL POWERED SYSTEM


L6647            UPPER EXTREMITY ADDITION, SHOULDER LOCK MECHANISM, BODY POWERED ACTUATOR                                             C       20030101    20030101


L6648            UPPER EXTREMITY ADDITION, SHOULDER LOCK MECHANISM, EXTERNAL POWERED ACTUATOR                                         C       20030101    20030101


L6650            UPPER EXTREMITY ADDITION, SHOULDER UNIVERSAL JOINT, EACH                                                             C       19860101    19960101


L6655            UPPER EXTREMITY ADDITION, STANDARD CONTROL CABLE, EXTRA                                                              C       19860101    19960101


L6660            UPPER EXTREMITY ADDITION, HEAVY DUTY CONTROL CABLE                                                                   C       19860101    19960101


L6665            UPPER EXTREMITY ADDITION, TEFLON, OR EQUAL, CABLE LINING                                                             C       19860101    19960101


L6670            UPPER EXTREMITY ADDITION, HOOK TO HAND, CABLE ADAPTER                                                                C       19860101    19960101


L6672            UPPER EXTREMITY ADDITION, HARNESS, CHEST OR SHOULDER, SADDLE TYPE                                                    C       19860101    19960101


L6675            UPPER EXTREMITY ADDITION, HARNESS, (E.G. FIGURE OF EIGHT TYPE), SINGLE CABLE DESIGN                                  C       19860101    20040101


L6676            UPPER EXTREMITY ADDITION, HARNESS, (E.G. FIGURE OF EIGHT TYPE), DUAL CABLE DESIGN                                    C       19860101    20040101


                 UPPER EXTREMITY ADDITION, HARNESS, TRIPLE CONTROL, SIMULTANEOUS OPERATION OF TERMINAL DEVICE
L6677                                                                                                                                 C       20060101    20060101
                 AND ELBOW


L6680            UPPER EXTREMITY ADDITION, TEST SOCKET, WRIST DISARTICULATION OR BELOW ELBOW                                          C       19860101    19960101


L6682            UPPER EXTREMITY ADDITION, TEST SOCKET, ELBOW DISARTICULATION OR ABOVE ELBOW                                          C       19860101    19960101


L6684            UPPER EXTREMITY ADDITION, TEST SOCKET, SHOULDER DISARTICULATION OR INTERSCAPULAR THORACIC                            C       19860101    19960101


L6686            UPPER EXTREMITY ADDITION, SUCTION SOCKET                                                                             C       19880101    19960101


L6687            UPPER EXTREMITY ADDITION, FRAME TYPE SOCKET, BELOW ELBOW OR WRIST DISARTICULATION                                    C       19880101    19960101


L6688            UPPER EXTREMITY ADDITION, FRAME TYPE SOCKET, ABOVE ELBOW OR ELBOW DISARTICULATION                                    C       19880101    19960101




                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date


L6689            UPPER EXTREMITY ADDITION, FRAME TYPE SOCKET, SHOULDER DISARTICULATION                                                C       19880101    19960101


L6690            UPPER EXTREMITY ADDITION, FRAME TYPE SOCKET, INTERSCAPULAR-THORACIC                                                  C       19880101    19960101


L6691            UPPER EXTREMITY ADDITION, REMOVABLE INSERT, EACH                                                                     C       19880101    19960101


L6692            UPPER EXTREMITY ADDITION, SILICONE GEL INSERT OR EQUAL, EACH                                                         C       19890101    19960101


L6693            UPPER EXTREMITY ADDITION, LOCKING ELBOW, FOREARM COUNTERBALANCE                                                      C       19990101    20000101


                 ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/ABOVE ELBOW, CUSTOM ELASTOMERIC OR
L6694                                                                                                                                 C       20050101    20050101
                 EQUAL, FOR USE WITH LOCKING MECHANISM

                 ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/ABOVE ELBOW, CUSTOM FABRICATED FROM
L6695            EXISTING MOLD OR PREFABRICATED, SOCKET INSERT, SILICONE GEL, ELASTOMERIC OR EQUAL, NOT FOR USE                       C       20050101    20050101
                 WITH LOCKING MECHANISM

                 ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/ABOVE ELBOW, CUSTOM FABRICATED SOCKET
                 INSERT FOR CONGENITAL OR ATYPICAL TRAUMATIC AMPUTEE, SILICONE GEL, ELASTOMERIC OR EQUAL, FOR
L6696                                                                                                                                 C       20050101    20050101
                 USE WITH OR WITHOUT LOCKING MECHANISM, INITIAL ONLY (FOR OTHER THAN INITIAL, USE CODE L6694 OR
                 L6695)


                 ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/ABOVE ELBOW, CUSTOM FABRICATED SOCKET
                 INSERT FOR OTHER THAN CONGENITAL OR ATYPICAL TRAUMATIC AMPUTEE, SILICONE GEL, ELASTOMERIC OR
L6697                                                                                                                                 C       20050101    20050101
                 EQUAL, FOR USE WITH OR WITHOUT LOCKING MECHANISM, INITIAL ONLY (FOR OTHER THAN INITIAL, USE CODE
                 L6694 OR L6695)

                 ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/ABOVE ELBOW, LOCK MECHANISM, EXCLUDES
L6698                                                                                                                                 C       20050101    20050101
                 SOCKET INSERT


L6700     D      TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #3                                                                  D       19860101    20070101     20061231


L6703     A      TERMINAL DEVICE, PASSIVE HAND/MITT, ANY MATERIAL, ANY SIZE                                                           C       20070101    20070101


L6704     A      TERMINAL DEVICE, SPORT/RECREATIONAL/WORK ATTACHMENT, ANY MATERIAL, ANY SIZE                                          C       20070101    20070101


L6705     D      TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #5                                                                  D       19860101    20070101     20061231


L6706     A      TERMINAL DEVICE, HOOK, MECHANICAL, VOLUNTARY OPENING, ANY MATERIAL, ANY SIZE, LINED OR UNLINED                       C       20070101    20070101


L6707     A      TERMINAL DEVICE, HOOK, MECHANICAL, VOLUNTARY CLOSING, ANY MATERIAL, ANY SIZE, LINED OR UNLINED                       C       20070101    20070101




                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date


L6708     A      TERMINAL DEVICE, HAND, MECHANICAL, VOLUNTARY OPENING, ANY MATERIAL, ANY SIZE                                         C       20070101    20070101


L6709     A      TERMINAL DEVICE, HAND, MECHANICAL, VOLUNTARY CLOSING, ANY MATERIAL, ANY SIZE                                         C       20070101    20070101


L6710     D      TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #5X                                                                 D       19860101    20070101     20061231


                 TERMINAL DEVICE, HOOK, MECHANICAL, VOLUNTARY OPENING, ANY MATERIAL, ANY SIZE, LINED OR UNLINED,
L6711     A                                                                                                                           C       20090101    20090101
                 PEDIATRIC

                 TERMINAL DEVICE, HOOK, MECHANICAL, VOLUNTARY CLOSING, ANY MATERIAL, ANY SIZE, LINED OR UNLINED,
L6712     A                                                                                                                           C       20090101    20090101
                 PEDIATRIC


L6713     A      TERMINAL DEVICE, HAND, MECHANICAL, VOLUNTARY OPENING, ANY MATERIAL, ANY SIZE, PEDIATRIC                              C       20090101    20090101


L6714     A      TERMINAL DEVICE, HAND, MECHANICAL, VOLUNTARY CLOSING, ANY MATERIAL, ANY SIZE, PEDIATRIC                              C       20090101    20090101


L6715     A      TERMINAL DEVICE, MULTIPLE ARTICULATING DIGIT, INCLUDES MOTOR(S), INITIAL ISSUE OR REPLACEMENT                        D       20120101    20120101


L6720     D      TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #6                                                                  D       19860101    20070101     20061231


                 TERMINAL DEVICE, HOOK OR HAND, HEAVY DUTY, MECHANICAL, VOLUNTARY OPENING, ANY MATERIAL, ANY
L6721     A                                                                                                                           C       20090101    20090101
                 SIZE, LINED OR UNLINED

                 TERMINAL DEVICE, HOOK OR HAND, HEAVY DUTY, MECHANICAL, VOLUNTARY CLOSING, ANY MATERIAL, ANY
L6722     A                                                                                                                           C       20090101    20090101
                 SIZE, LINED OR UNLINED


L6725     D      TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #7                                                                  D       19860101    20070101     20061231


L6730     D      TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #7LO                                                                D       19860101    20070101     20061231


L6735     D      TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #8                                                                  D       19860101    20070101     20061231


L6740     D      TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #8X                                                                 D       19860101    20070101     20061231


L6745     D      TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #88X                                                                D       19860101    20070101     20061231


L6750     D      TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #10P                                                                D       19860101    20070101     20061231


L6755     D      TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #10X                                                                D       19860101    20070101     20061231




                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                   Code Add   Action Eff
HCPCS            Long Description                                                                                                     Coverage                           Term Date
        Code                                                                                                                                       Date       Date


L6765     D      TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #12P                                                                   D       19860101    20070101     20061231


L6770     D      TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #99X                                                                   D       19860101    20070101     20061231


L6775     D      TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #555                                                                   D       19860101    20070101     20061231


L6780     D      TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #SS555                                                                 D       19860101    20070101     20061231


L6790     D      TERMINAL DEVICE, HOOK-ACCU HOOK, OR EQUAL                                                                               D       19860101    20070101     20061231


L6795     D      TERMINAL DEVICE, HOOK-2 LOAD, OR EQUAL                                                                                  D       19860101    20070101     20061231


L6800     D      TERMINAL DEVICE, HOOK-APRL VC, OR EQUAL                                                                                 D       19860101    20070101     20061231


L6805     C      ADDITION TO TERMINAL DEVICE, MODIFIER WRIST UNIT                                                                        D       19850101    20070101


L6806     D      TERMINAL DEVICE, HOOK, TRS GRIP, GRIP III, VC, OR EQUAL                                                                 D       19880101    20070101     20061231


L6807     D      TERMINAL DEVICE, HOOK, GRIP I, GRIP II, VC, OR EQUAL                                                                    D       19880101    20070101     20061231


L6808     D      TERMINAL DEVICE, HOOK, TRS ADEPT, INFANT OR CHILD, VC, OR EQUAL                                                         D       19880101    20070101     20061231


L6809     D      TERMINAL DEVICE, HOOK, TRS SUPER SPORT, PASSIVE                                                                         D       19880101    20070101     20061231


L6810     C      ADDITION TO TERMINAL DEVICE, PRECISION PINCH DEVICE                                                                     D       19880101    20070101


L6825     D      TERMINAL DEVICE, HAND, DORRANCE, VO                                                                                     D       19820101    20070101     20061231


L6830     D      TERMINAL DEVICE, HAND, APRL, VC                                                                                         D       19860101    20070101     20061231


L6835     D      TERMINAL DEVICE, HAND, SIERRA, VO                                                                                       D       19860101    20070101     20061231


L6840     D      TERMINAL DEVICE, HAND, BECKER IMPERIAL                                                                                  D       19860101    20070101     20061231


L6845     D      TERMINAL DEVICE, HAND, BECKER LOCK GRIP                                                                                 D       19860101    20070101     20061231




                                                           Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                 Code Add   Action Eff
HCPCS            Long Description                                                                                                   Coverage                           Term Date
        Code                                                                                                                                     Date       Date


L6850     D      TERMINAL DEVICE, HAND, BECKER PLYLITE                                                                                 D       19860101    20070101     20061231


L6855     D      TERMINAL DEVICE, HAND, ROBIN-AIDS, VO                                                                                 D       19860101    20070101     20061231


L6860     D      TERMINAL DEVICE, HAND, ROBIN-AIDS, VO SOFT                                                                            D       19860101    20070101     20061231


L6865     D      TERMINAL DEVICE, HAND, PASSIVE HAND                                                                                   D       19860101    20070101     20061231


L6867     D      TERMINAL DEVICE, HAND, DETROIT INFANT HAND (MECHANICAL)                                                               D       19880101    20070101     20061231


L6868     D      TERMINAL DEVICE, HAND, PASSIVE INFANT HAND, (STEEPER, HOSMER OR EQUAL)                                                D       19880101    20070101     20061231


L6870     D      TERMINAL DEVICE, HAND, CHILD MITT                                                                                     D       19860101    20070101     20061231


L6872     D      TERMINAL DEVICE, HAND, NYU CHILD HAND                                                                                 D       19880101    20070101     20061231


L6873     D      TERMINAL DEVICE, HAND, MECHANICAL INFANT HAND, STEEPER OR EQUAL                                                       D       19880101    20070101     20061231


L6875     D      TERMINAL DEVICE, HAND, BOCK, VC                                                                                       D       19860101    20070101     20061231


                 ELECTRIC HAND, SWITCH OR MYOLELECTRIC CONTROLLED, INDEPENDENTLY ARTICULATING DIGITS, ANY
L6880     A                                                                                                                            D       20120101    20120101
                 GRASP PATTERN OR COMBINATION OF GRASP PATTERNS, INCLUDES MOTOR(S)


L6881     C      AUTOMATIC GRASP FEATURE, ADDITION TO UPPER LIMB ELECTRIC PROSTHETIC TERMINAL DEVICE                                   C       20020101    20070101


L6882            MICROPROCESSOR CONTROL FEATURE, ADDITION TO UPPER LIMB PROSTHETIC TERMINAL DEVICE                                     D       20020101    20020101


                 REPLACEMENT SOCKET, BELOW ELBOW/WRIST DISARTICULATION, MOLDED TO PATIENT MODEL, FOR USE
L6883                                                                                                                                  C       20060101    20060101
                 WITH OR WITHOUT EXTERNAL POWER

                 REPLACEMENT SOCKET, ABOVE ELBOW/ELBOW DISARTICULATION, MOLDED TO PATIENT MODEL, FOR USE
L6884     C                                                                                                                            C       20060101    20070101
                 WITH OR WITHOUT EXTERNAL POWER

                 REPLACEMENT SOCKET, SHOULDER DISARTICULATION/INTERSCAPULAR THORACIC, MOLDED TO PATIENT
L6885                                                                                                                                  C       20060101    20060101
                 MODEL, FOR USE WITH OR WITHOUT EXTERNAL POWER

                 ADDITION TO UPPER EXTREMITY PROSTHESIS, GLOVE FOR TERMINAL DEVICE, ANY MATERIAL,
L6890                                                                                                                                  C       19860101    20050101
                 PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

                 ADDITION TO UPPER EXTREMITY PROSTHESIS, GLOVE FOR TERMINAL DEVICE, ANY MATERIAL, CUSTOM
L6895                                                                                                                                  C       19860101    20050101
                 FABRICATED



                                                         Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                              Code Add   Action Eff
HCPCS            Long Description                                                                                                Coverage                           Term Date
        Code                                                                                                                                  Date       Date

                 HAND RESTORATION (CASTS, SHADING AND MEASUREMENTS INCLUDED), PARTIAL HAND, WITH GLOVE, THUMB
L6900                                                                                                                               C       19820101    19960101
                 OR ONE FINGER REMAINING

                 HAND RESTORATION (CASTS, SHADING AND MEASUREMENTS INCLUDED), PARTIAL HAND, WITH GLOVE,
L6905                                                                                                                               C       19860101    19960101
                 MULTIPLE FINGERS REMAINING

                 HAND RESTORATION (CASTS, SHADING AND MEASUREMENTS INCLUDED), PARTIAL HAND, WITH GLOVE, NO
L6910                                                                                                                               C       19820101    19960101
                 FINGERS REMAINING


L6915            HAND RESTORATION (SHADING, AND MEASUREMENTS INCLUDED), REPLACEMENT GLOVE FOR ABOVE                                 C       19820101    19960101


                 WRIST DISARTICULATION, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE FOREARM
L6920            SHELL, OTTO BOCK OR EQUAL, SWITCH, CABLES, TWO BATTERIES AND ONE CHARGER, SWITCH CONTROL OF                        C       19880101    19960101
                 TERMINAL DEVICE

                 WRIST DISARTICULATION, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE FOREARM
L6925            SHELL, OTTO BOCK OR EQUAL ELECTRODES, CABLES, TWO BATTERIES AND ONE CHARGER, MYOELECTRONIC                         C       19880101    19960101
                 CONTROL OF TERMINAL DEVICE

                 BELOW ELBOW, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE FOREARM SHELL, OTTO
L6930            BOCK OR EQUAL SWITCH, CABLES, TWO BATTERIES AND ONE CHARGER, SWITCH CONTROL OF TERMINAL                            C       19880101    19960101
                 DEVICE

                 BELOW ELBOW, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE FOREARM SHELL, OTTO
L6935            BOCK OR EQUAL ELECTRODES, CABLES, TWO BATTERIES AND ONE CHARGER, MYOELECTRONIC CONTROL OF                          C       19880101    19960101
                 TERMINAL DEVICE

                 ELBOW DISARTICULATION, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL SHELL,
L6940            OUTSIDE LOCKING HINGES, FOREARM, OTTO BOCK OR EQUAL SWITCH, CABLES, TWO BATTERIES AND ONE                          C       19880101    19960101
                 CHARGER, SWITCH CONTROL OF TERMINAL DEVICE

                 ELBOW DISARTICULATION, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL SHELL,
L6945            OUTSIDE LOCKING HINGES, FOREARM, OTTO BOCK OR EQUAL ELECTRODES, CABLES, TWO BATTERIES AND                          C       19880101    19960101
                 ONE CHARGER, MYOELECTRONIC CONTROL OF TERMINAL DEVICE

                 ABOVE ELBOW, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL SHELL, INTERNAL
L6950            LOCKING ELBOW, FOREARM, OTTO BOCK OR EQUAL SWITCH, CABLES, TWO BATTERIES AND ONE CHARGER,                          C       19880101    19960101
                 SWITCH CONTROL OF TERMINAL DEVICE

                 ABOVE ELBOW, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL SHELL, INTERNAL
L6955            LOCKING ELBOW, FOREARM, OTTO BOCK OR EQUAL ELECTRODES, CABLES, TWO BATTERIES AND ONE                               C       19880101    19960101
                 CHARGER, MYOELECTRONIC CONTROL OF TERMINAL DEVICE

                 SHOULDER DISARTICULATION, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE SHOULDER SHELL,
L6960            SHOULDER BULKHEAD, HUMERAL SECTION, MECHANICAL ELBOW, FOREARM, OTTO BOCK OR EQUAL SWITCH,                          C       19880101    19960101
                 CABLES, TWO BATTERIES AND ONE CHARGER, SWITCH CONTROL OF TERMINAL DEVICE

                 SHOULDER DISARTICULATION, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE SHOULDER SHELL,
                 SHOULDER BULKHEAD, HUMERAL SECTION, MECHANICAL ELBOW, FOREARM, OTTO BOCK OR EQUAL
L6965                                                                                                                               C       19880101    19960101
                 ELECTRODES, CABLES, TWO BATTERIES AND ONE CHARGER, MYOELECTRONIC CONTROL OF TERMINAL
                 DEVICE

                 INTERSCAPULAR-THORACIC, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE SHOULDER SHELL,
L6970            SHOULDER BULKHEAD, HUMERAL SECTION, MECHANICAL ELBOW, FOREARM, OTTO BOCK OR EQUAL SWITCH,                          C       19880101    19960101
                 CABLES, TWO BATTERIES AND ONE CHARGER, SWITCH CONTROL OF TERMINAL DEVICE



                                                      Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                              Code Add   Action Eff
HCPCS            Long Description                                                                                                Coverage                           Term Date
        Code                                                                                                                                  Date       Date

                 INTERSCAPULAR-THORACIC, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE SHOULDER SHELL,
                 SHOULDER BULKHEAD, HUMERAL SECTION, MECHANICAL ELBOW, FOREARM, OTTO BOCK OR EQUAL
L6975                                                                                                                               C       19880101    19960101
                 ELECTRODES, CABLES, TWO BATTERIES AND ONE CHARGER, MYOELECTRONIC CONTROL OF TERMINAL
                 DEVICE


L7007     A      ELECTRIC HAND, SWITCH OR MYOELECTRIC CONTROLLED, ADULT                                                             C       20070101    20070101


L7008     A      ELECTRIC HAND, SWITCH OR MYOELECTRIC CONTROLLED, PEDIATRIC                                                         C       20070101    20070101


L7009     A      ELECTRIC HOOK, SWITCH OR MYOELECTRIC CONTROLLED, ADULT                                                             C       20070101    20070101


L7010     D      ELECTRONIC HAND, OTTO BOCK, STEEPER OR EQUAL, SWITCH CONTROLLED                                                    C       19880101    20070101     20061231


L7015     D      ELECTRONIC HAND, SYSTEM TEKNIK, VARIETY VILLAGE OR EQUAL, SWITCH CONTROLLED                                        C       19880101    20070101     20061231


L7020     D      ELECTRONIC GREIFER, OTTO BOCK OR EQUAL, SWITCH CONTROLLED                                                          C       19880101    20070101     20061231


L7025     D      ELECTRONIC HAND, OTTO BOCK OR EQUAL, MYOELECTRONICALLY CONTROLLED                                                  C       19880101    20070101     20061231


L7030     D      ELECTRONIC HAND, SYSTEM TEKNIK, VARIETY VILLAGE OR EQUAL, MYOELECTRONICALLY CONTROLLED                             C       19880101    20070101     20061231


L7035     D      ELECTRONIC GREIFER, OTTO BOCK OR EQUAL, MYOELECTRONICALLY CONTROLLED                                               C       19880101    20070101     20061231


L7040     C      PREHENSILE ACTUATOR, SWITCH CONTROLLED                                                                             C       19880101    20070101


L7045     C      ELECTRONIC HOOK, SWITCH OR MYOELECTRIC CONTROLLED, PEDIATRIC                                                       C       19880101    20070101


L7170            ELECTRONIC ELBOW, HOSMER OR EQUAL, SWITCH CONTROLLED                                                               C       19880101    19960101


L7180            ELECTRONIC ELBOW, MICROPROCESSOR SEQUENTIAL CONTROL OF ELBOW AND TERMINAL DEVICE                                   C       19880101    20050101


L7181            ELECTRONIC ELBOW, MICROPROCESSOR SIMULTANEOUS CONTROL OF ELBOW AND TERMINAL DEVICE                                 C       20050101    20050101


L7185            ELECTRONIC ELBOW, ADOLESCENT, VARIETY VILLAGE OR EQUAL, SWITCH CONTROLLED                                          C       19880101    19960101


L7186            ELECTRONIC ELBOW, CHILD, VARIETY VILLAGE OR EQUAL, SWITCH CONTROLLED                                               C       19890101    19960101




                                                      Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                               Code Add   Action Eff
HCPCS            Long Description                                                                                                 Coverage                           Term Date
        Code                                                                                                                                   Date       Date


L7190            ELECTRONIC ELBOW, ADOLESCENT, VARIETY VILLAGE OR EQUAL, MYOELECTRONICALLY CONTROLLED                                C       19880101    19960101


L7191            ELECTRONIC ELBOW, CHILD, VARIETY VILLAGE OR EQUAL, MYOELECTRONICALLY CONTROLLED                                     C       19890101    19960101


L7260            ELECTRONIC WRIST ROTATOR, OTTO BOCK OR EQUAL                                                                        C       19880101    19960101


L7261            ELECTRONIC WRIST ROTATOR, FOR UTAH ARM                                                                              C       19880101    19960101


L7266     D      SERVO CONTROL, STEEPER OR EQUAL                                                                                     C       19880101    19960101     20111231


L7272     D      ANALOGUE CONTROL, UNB OR EQUAL                                                                                      C       19880101    19960101     20111231


L7274     D      PROPORTIONAL CONTROL, 6-12 VOLT, LIBERTY, UTAH OR EQUAL                                                             C       19880101    19970101     20111231


L7360     C      SIX VOLT BATTERY, EACH                                                                                              C       19880101    20080101


L7362     C      BATTERY CHARGER, SIX VOLT, EACH                                                                                     C       19880101    20080101


L7364     C      TWELVE VOLT BATTERY, EACH                                                                                           C       19880101    20080101


L7366     C      BATTERY CHARGER, TWELVE VOLT, EACH                                                                                  C       19880101    20080101


L7367            LITHIUM ION BATTERY, REPLACEMENT                                                                                    C       20030101    20030101


L7368     C      LITHIUM ION BATTERY CHARGER, REPLACEMENT ONLY                                                                       C       20030101    20120101


                 ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/WRIST DISARTICULATION, ULTRALIGHT
L7400                                                                                                                                C       20060101    20060101
                 MATERIAL (TITANIUM, CARBON FIBER OR EQUAL)

                 ADDITION TO UPPER EXTREMITY PROSTHESIS, ABOVE ELBOW DISARTICULATION, ULTRALIGHT MATERIAL
L7401                                                                                                                                C       20060101    20060101
                 (TITANIUM, CARBON FIBER OR EQUAL)

                 ADDITION TO UPPER EXTREMITY PROSTHESIS, SHOULDER DISARTICULATION/INTERSCAPULAR THORACIC,
L7402                                                                                                                                C       20060101    20060101
                 ULTRALIGHT MATERIAL (TITANIUM, CARBON FIBER OR EQUAL)


L7403            ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/WRIST DISARTICULATION, ACRYLIC MATERIAL                         C       20060101    20060101


L7404            ADDITION TO UPPER EXTREMITY PROSTHESIS, ABOVE ELBOW DISARTICULATION, ACRYLIC MATERIAL                               C       20060101    20060101




                                                       Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date

                 ADDITION TO UPPER EXTREMITY PROSTHESIS, SHOULDER DISARTICULATION/INTERSCAPULAR THORACIC,
L7405                                                                                                                                 C       20060101    20060101
                 ACRYLIC MATERIAL


L7499            UPPER EXTREMITY PROSTHESIS, NOT OTHERWISE SPECIFIED                                                                  C       19850101    19980101


                 REPAIR OF PROSTHETIC DEVICE, HOURLY RATE (EXCLUDES V5335 REPAIR OF ORAL OR LARYNGEAL
L7500     D                                                                                                                           D       19820101    19960101     20111231
                 PROSTHESIS OR ARTIFICIAL LARYNX)


L7510            REPAIR OF PROSTHETIC DEVICE, REPAIR OR REPLACE MINOR PARTS                                                           D       19850101    20030101


L7520            REPAIR PROSTHETIC DEVICE, LABOR COMPONENT, PER 15 MINUTES                                                            C       19970101    20000101


L7600            PROSTHETIC DONNING SLEEVE, ANY MATERIAL, EACH                                                                        C       20060101    20060101


                 TERMINAL DEVICE, HOOK, MECHANICAL, VOLUNTARY OPENING, ANY MATERIAL, ANY SIZE, LINED OR UNLINED,
L7611     D                                                                                                                           C       20080101    20080101     20081231
                 PEDIATRIC

                 TERMINAL DEVICE, HOOK, MECHANICAL, VOLUNTARY CLOSING, ANY MATERIAL, ANY SIZE, LINED OR UNLINED,
L7612     D                                                                                                                           C       20080101    20080101     20081231
                 PEDIATRIC


L7613     D      TERMINAL DEVICE, HAND, MECHANICAL, VOLUNTARY OPENING, ANY MATERIAL, ANY SIZE, PEDIATRIC                              C       20080101    20080101     20081231


L7614     D      TERMINAL DEVICE, HAND, MECHANICAL, VOLUNTARY CLOSING, ANY MATERIAL, ANY SIZE, PEDIATRIC                              C       20080101    20080101     20081231


                 TERMINAL DEVICE, HOOK OR HAND, HEAVY DUTY, MECHANICAL, VOLUNTARY OPENING, ANY MATERIAL, ANY
L7621     D                                                                                                                           C       20080101    20080101     20081231
                 SIZE, LINED OR UNLINED

                 TERMINAL DEVICE, HOOK OR HAND, HEAVY DUTY, MECHANICAL, VOLUNTARY CLOSING, ANY MATERIAL, ANY
L7622     D                                                                                                                           C       20080101    20080101     20081231
                 SIZE, LINED OR UNLINED


L7900            MALE VACUUM ERECTION SYSTEM                                                                                          C       19970101    20030101


L8000            BREAST PROSTHESIS, MASTECTOMY BRA                                                                                    D       19860101    19960101


L8001            BREAST PROSTHESIS, MASTECTOMY BRA, WITH INTEGRATED BREAST PROSTHESIS FORM, UNILATERAL                                D       20020101    20020101


L8002            BREAST PROSTHESIS, MASTECTOMY BRA, WITH INTEGRATED BREAST PROSTHESIS FORM, BILATERAL                                 D       20020101    20020101


L8010     P      BREAST PROSTHESIS, MASTECTOMY SLEEVE                                                                                 D       19860101    20050401


L8015            EXTERNAL BREAST PROSTHESIS GARMENT, WITH MASTECTOMY FORM, POST MASTECTOMY                                            D       19990101    19990101




                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                               Code Add   Action Eff
HCPCS            Long Description                                                                                                 Coverage                           Term Date
        Code                                                                                                                                   Date       Date


L8020            BREAST PROSTHESIS, MASTECTOMY FORM                                                                                  D       19860101    19960101


L8030     C      BREAST PROSTHESIS, SILICONE OR EQUAL, WITHOUT INTEGRAL ADHESIVE                                                     D       19890101    20100101


L8031     A      BREAST PROSTHESIS, SILICONE OR EQUAL, WITH INTEGRAL ADHESIVE                                                        D       20100101    20100101


L8032     A      NIPPLE PROSTHESIS, REUSABLE, ANY TYPE, EACH                                                                         D       20100101    20100101


L8035            CUSTOM BREAST PROSTHESIS, POST MASTECTOMY, MOLDED TO PATIENT MODEL                                                  D       19990101    19990101


L8039            BREAST PROSTHESIS, NOT OTHERWISE SPECIFIED                                                                          C       19980101    19980101


L8040            NASAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN                                                                       C       20010101    20010101


L8041            MIDFACIAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN                                                                   C       20010101    20010101


L8042            ORBITAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN                                                                     C       20010101    20010101


L8043            UPPER FACIAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN                                                                C       20010101    20010101


L8044            HEMI-FACIAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN                                                                 C       20010101    20010101


L8045            AURICULAR PROSTHESIS, PROVIDED BY A NON-PHYSICIAN                                                                   C       20010101    20010101


L8046            PARTIAL FACIAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN                                                              C       20010101    20010101


L8047            NASAL SEPTAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN                                                                C       20010101    20010101


L8048            UNSPECIFIED MAXILLOFACIAL PROSTHESIS, BY REPORT, PROVIDED BY A NON-PHYSICIAN                                        C       20010101    20010101


                 REPAIR OR MODIFICATION OF MAXILLOFACIAL PROSTHESIS, LABOR COMPONENT, 15 MINUTE INCREMENTS,
L8049                                                                                                                                C       20010101    20010101
                 PROVIDED BY A NON-PHYSICIAN


L8100     D      GRADIENT COMPRESSION STOCKING, BELOW KNEE, 18-30 MMHG, EACH                                                         M       19860101    20060101     20051231


L8110     D      GRADIENT COMPRESSION STOCKING, BELOW KNEE, 30-40 MMHG, EACH                                                         D       19860101    20060101     20051231




                                                       Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                              Code Add   Action Eff
HCPCS            Long Description                                                                                                Coverage                           Term Date
        Code                                                                                                                                  Date       Date


L8120     D      GRADIENT COMPRESSION STOCKING, BELOW KNEE, 40-50 MMHG, EACH                                                        D       19860101    20060101     20051231


L8130     D      GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 18-30 MMHG, EACH                                                      M       19860101    20060101     20051231


L8140     D      GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 30-40 MMHG, EACH                                                      M       19860101    20060101     20051231


L8150     D      GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 40-50 MMHG, EACH                                                      M       19860101    20060101     20051231


L8160     D      GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 18-30 MMHG, EACH                                            M       19860101    20060101     20051231


L8170     D      GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 30-40 MMHG, EACH                                            M       19860101    20060101     20051231


L8180     D      GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 40-50 MMHG, EACH                                            M       19860101    20060101     20051231


L8190     D      GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 18-30 MMHG, EACH                                                      M       19860101    20060101     20051231


L8195     D      GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 30-40 MMHG, EACH                                                      M       19990101    20060101     20051231


L8200     D      GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 40-50 MMHG, EACH                                                      M       19860101    20060101     20051231


L8210     D      GRADIENT COMPRESSION STOCKING, CUSTOM MADE                                                                         M       19860101    20060101     20051231


L8220     D      GRADIENT COMPRESSION STOCKING, LYMPHEDEMA                                                                          M       19860101    20060101     20051231


L8230     D      GRADIENT COMPRESSION STOCKING, GARTER BELT                                                                         M       19860101    20060101     20051231


L8239     D      GRADIENT COMPRESSION STOCKING, NOT OTHERWISE SPECIFIED                                                             C       19980101    20060101     20051231


L8300            TRUSS, SINGLE WITH STANDARD PAD                                                                                    D       19860101    19960101


L8310            TRUSS, DOUBLE WITH STANDARD PADS                                                                                   D       19860101    19960101


L8320            TRUSS, ADDITION TO STANDARD PAD, WATER PAD                                                                         D       19860101    19960101


L8330            TRUSS, ADDITION TO STANDARD PAD, SCROTAL PAD                                                                       D       19860101    19960101




                                                      Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                 Code Add   Action Eff
HCPCS            Long Description                                                                                                   Coverage                           Term Date
        Code                                                                                                                                     Date       Date


L8400            PROSTHETIC SHEATH, BELOW KNEE, EACH                                                                                   D       19820101    19960101


L8410            PROSTHETIC SHEATH, ABOVE KNEE, EACH                                                                                   D       19820101    19960101


L8415            PROSTHETIC SHEATH, UPPER LIMB, EACH                                                                                   D       19880101    19960101


L8417            PROSTHETIC SHEATH/SOCK, INCLUDING A GEL CUSHION LAYER, BELOW KNEE OR ABOVE KNEE, EACH                                 C       19970101    19970101


L8420            PROSTHETIC SOCK, MULTIPLE PLY, BELOW KNEE, EACH                                                                       D       19820101    19990101


L8430            PROSTHETIC SOCK, MULTIPLE PLY, ABOVE KNEE, EACH                                                                       D       19820101    19990101


L8435            PROSTHETIC SOCK, MULTIPLE PLY, UPPER LIMB, EACH                                                                       D       19880101    20000101


L8440            PROSTHETIC SHRINKER, BELOW KNEE, EACH                                                                                 D       19820101    19960101


L8460            PROSTHETIC SHRINKER, ABOVE KNEE, EACH                                                                                 D       19820101    19960101


L8465            PROSTHETIC SHRINKER, UPPER LIMB, EACH                                                                                 D       19880101    19960101


L8470            PROSTHETIC SOCK, SINGLE PLY, FITTING, BELOW KNEE, EACH                                                                D       19820101    19990101


L8480            PROSTHETIC SOCK, SINGLE PLY, FITTING, ABOVE KNEE, EACH                                                                D       19820101    19990101


L8485            PROSTHETIC SOCK, SINGLE PLY, FITTING, UPPER LIMB, EACH                                                                D       19940101    19990101


L8490     D      ADDITION TO PROSTHETIC SHEATH/SOCK, AIR SEAL SUCTION RETENTION SYSTEM                                                 C       19940101    20050101     20041231


L8499            UNLISTED PROCEDURE FOR MISCELLANEOUS PROSTHETIC SERVICES                                                              C       19820101    20020101


L8500            ARTIFICIAL LARYNX, ANY TYPE                                                                                           D       19900101    19960101


L8501            TRACHEOSTOMY SPEAKING VALVE                                                                                           D       19900101    19960101


L8505            ARTIFICIAL LARYNX REPLACEMENT BATTERY / ACCESSORY, ANY TYPE                                                           C       20020101    20020101




                                                         Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date


L8507            TRACHEO-ESOPHAGEAL VOICE PROSTHESIS, PATIENT INSERTED, ANY TYPE, EACH                                                C       20020101    20020101


L8509            TRACHEO-ESOPHAGEAL VOICE PROSTHESIS, INSERTED BY A LICENSED HEALTH CARE PROVIDER, ANY TYPE                           C       20020101    20020101


L8510            VOICE AMPLIFIER                                                                                                      D       20020101    20020101


                 INSERT FOR INDWELLING TRACHEOESOPHAGEAL PROSTHESIS, WITH OR WITHOUT VALVE, REPLACEMENT
L8511                                                                                                                                 C       20040101    20040101
                 ONLY, EACH

                 GELATIN CAPSULES OR EQUIVALENT, FOR USE WITH TRACHEOESOPHAGEAL VOICE PROSTHESIS,
L8512                                                                                                                                 C       20040101    20040101
                 REPLACEMENT ONLY, PER 10

                 CLEANING DEVICE USED WITH TRACHEOESOPHAGEAL VOICE PROSTHESIS, PIPET, BRUSH, OR EQUAL,
L8513                                                                                                                                 C       20040101    20040101
                 REPLACEMENT ONLY, EACH


L8514            TRACHEOESOPHAGEAL PUNCTURE DILATOR, REPLACEMENT ONLY, EACH                                                           C       20040101    20040101


L8515            GELATIN CAPSULE, APPLICATION DEVICE FOR USE WITH TRACHEOESOPHAGEAL VOICE PROSTHESIS, EACH                            C       20050101    20050101


L8600            IMPLANTABLE BREAST PROSTHESIS, SILICONE OR EQUAL                                                                     D       19920101    19971001


                 INJECTABLE BULKING AGENT, COLLAGEN IMPLANT, URINARY TRACT, 2.5 ML SYRINGE, INCLUDES SHIPPING AND
L8603                                                                                                                                 D       19950101    20010101
                 NECESSARY SUPPLIES

                 INJECTABLE BULKING AGENT, DEXTRANOMER/HYALURONIC ACID COPOLYMER IMPLANT,
L8604     A                                                                                                                           D       20090101    20090101
                 URINARY TRACT, 1 ML, INCLUDES SHIPPING AND NECESSARY SUPPLIES

                 INJECTABLE BULKING AGENT, SYNTHETIC IMPLANT, URINARY TRACT, 1 ML SYRINGE, INCLUDES SHIPPING AND
L8606                                                                                                                                 D       20010101    20010101
                 NECESSARY SUPPLIES


L8609            ARTIFICIAL CORNEA                                                                                                    C       20060101    20060101


L8610            OCULAR IMPLANT                                                                                                       D       19920101    19971001


L8612            AQUEOUS SHUNT                                                                                                        D       19920101    19971001


L8613            OSSICULA IMPLANT                                                                                                     D       19920101    19971001


L8614     C      COCHLEAR DEVICE, INCLUDES ALL INTERNAL AND EXTERNAL COMPONENTS                                                       D       19920101    20070101


L8615            HEADSET/HEADPIECE FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT                                                  D       20050101    20050101




                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                                Code Add   Action Eff
HCPCS            Long Description                                                                                                  Coverage                           Term Date
        Code                                                                                                                                    Date       Date


L8616            MICROPHONE FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT                                                         D       20050101    20050101


L8617            TRANSMITTING COIL FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT                                                  D       20050101    20050101


L8618            TRANSMITTER CABLE FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT                                                  D       20050101    20050101


L8619            COCHLEAR IMPLANT EXTERNAL SPEECH PROCESSOR, REPLACEMENT                                                              D       19960101    19960916


L8620     D      LITHIUM ION BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT, EACH                                          I       20050101    20060101     20051231


L8621            ZINC AIR BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT, EACH                                             C       20050101    20050101


L8622            ALKALINE BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE, ANY SIZE, REPLACEMENT, EACH                                   C       20050101    20050101


                 LITHIUM ION BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE SPEECH PROCESSOR, OTHER THAN EAR
L8623                                                                                                                                 C       20060101    20060101
                 LEVEL, REPLACEMENT, EACH

                 LITHIUM ION BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE SPEECH PROCESSOR, EAR LEVEL,
L8624                                                                                                                                 C       20060101    20060101
                 REPLACEMENT, EACH


L8630            METACARPOPHALANGEAL JOINT IMPLANT                                                                                    D       19920101    19971001


                 METACARPAL PHALANGEAL JOINT REPLACEMENT, TWO OR MORE PIECES, METAL (E.G., STAINLESS STEEL OR
L8631            COBALT CHROME), CERAMIC-LIKE MATERIAL (E.G., PYROCARBON), FOR SURGICAL IMPLANTATION (ALL SIZES,                      D       20040101    20040101
                 INCLUDES ENTIRE SYSTEM)


L8641            METATARSAL JOINT IMPLANT                                                                                             D       19920101    19971001


L8642            HALLUX IMPLANT                                                                                                       D       19920101    19971001


L8658            INTERPHALANGEAL JOINT SPACER, SILICONE OR EQUAL, EACH                                                                D       19920101    20040101


                 INTERPHALANGEAL FINGER JOINT REPLACEMENT, 2 OR MORE PIECES, METAL (E.G., STAINLESS STEEL OR
L8659                                                                                                                                 D       20040101    20040101
                 COBALT CHROME), CERAMIC-LIKE MATERIAL (E.G., PYROCARBON) FOR SURGICAL IMPLANTATION, ANY SIZE


L8670            VASCULAR GRAFT MATERIAL, SYNTHETIC, IMPLANT                                                                          D       19920101    19971001


L8680            IMPLANTABLE NEUROSTIMULATOR ELECTRODE, EACH                                                                          D       20060101    20060101


                 PATIENT PROGRAMMER (EXTERNAL) FOR USE WITH IMPLANTABLE PROGRAMMABLE
L8681     C                                                                                                                           D       20060101    20090101
                 NEUROSTIMULATOR PULSE GENERATOR, REPLACEMENT ONLY


                                                        Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC
        Action                                                                                                                              Code Add   Action Eff
HCPCS            Long Description                                                                                                Coverage                           Term Date
        Code                                                                                                                                  Date       Date


L8682            IMPLANTABLE NEUROSTIMULATOR RADIOFREQUENCY RECEIVER                                                                D       20060101    20060101


                 RADIOFREQUENCY TRANSMITTER (EXTERNAL) FOR USE WITH IMPLANTABLE NEUROSTIMULATOR
L8683                                                                                                                               D       20060101    20060101
                 RADIOFREQUENCY RECEIVER

                 RADIOFREQUENCY TRANSMITTER (EXTERNAL) FOR USE WITH IMPLANTABLE SACRAL ROOT
L8684                                                                                                                               D       20060101    20060101
                 NEUROSTIMULATOR RECEIVER FOR BOWEL AND BLADDER MANAGEMENT, REPLACEMENT

                 IMPLANTABLE NEUROSTIMULATOR PULSE GENERATOR, SINGLE ARRAY, RECHARGEABLE, INCLUDES
L8685                                                                                                                               D       20060101    20060101
                 EXTENSION

                 IMPLANTABLE NEUROSTIMULATOR PULSE GENERATOR, SINGLE ARRAY, NON-RECHARGEABLE, INCLUDES
L8686                                                                                                                               D       20060101    20060101
                 EXTENSION


L8687            IMPLANTABLE NEUROSTIMULATOR PULSE GENERATOR, DUAL ARRAY, RECHARGEABLE, INCLUDES EXTENSION                          D       20060101    20060101


                 IMPLANTABLE NEUROSTIMULATOR PULSE GENERATOR, DUAL ARRAY, NON-RECHARGEABLE, INCLUDES
L8688                                                                                                                               D       20060101    20060101
                 EXTENSION

                 EXTERNAL RECHARGING SYSTEM FOR BATTERY (INTERNAL) FOR USE WITH IMPLANTABLE
L8689     C                                                                                                                         D       20060101    20090101
                 NEUROSTIMULATOR, REPLACEMENT ONLY


L8690     A      AUDITORY OSSEOINTEGRATED DEVICE, INCLUDES ALL INTERNAL AND EXTERNAL COMPONENTS                                     C       20070101    20070101


L8691     A      AUDITORY OSSEOINTEGRATED DEVICE, EXTERNAL SOUND PROCESSOR, REPLACEMENT                                             C       20070101    20070101


                 EXTERNAL RECHARGING SYSTEM FOR BATTERY (EXTERNAL) FOR USE WITH IMPLANTABLE
L8695     C                                                                                                                         D       20070101    20090101
                 NEUROSTIMULATOR, REPLACEMENT ONLY


L8699            PROSTHETIC IMPLANT, NOT OTHERWISE SPECIFIED                                                                        C       19980101    19980101


                 ORTHOTIC AND PROSTHETIC SUPPLY, ACCESSORY, AND/OR SERVICE COMPONENT OF ANOTHER HCPCS "L"
L9900                                                                                                                               C       20000101    20000101
                 CODE




                                                      Note: Items in BOLD are Updates and items in BLUE are invalid to DME MAC

				
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