Coding for functional orthotics falls with the Healthcare Procedural Coding System, Level II codes, also known as “Hick Picks” codes. In 2012, representatives from three primary specialty associations* met to discuss the most common orthotic codes. The organizations mutually agreed on the more detailed guidelines for the device codes. Although the detailed guidelines are not formally part of the HCPCS code set descriptors, the guidelines have been adopted by some carriers as the descriptors that they will follow.

L3000

Foot insert, removable, molded to patient model, UCB type, Berkeley shell, each:

This type of device is custom fabricated from a three-dimensional model of the patient’s foot (e.g., cast, foam impression, or virtual true 3-D digital image). This type of orthotic is a functional device, (reducing pathological forces) that has a molded heel cup and trim lines with a minimum of a 10 mm heel cup height to provide both medial and lateral directive forces to control the hind and forefoot. It may also have intrinsic or extrinsic posts designed to control foot motion. This device is made of a sufficiently rigid material to control function and reduce pathological forces. HCPCS code L3000 includes additions such as postings, padded top covers, soft tissue supplements, balance padding, and lesion or structure accommodations. Other additions may be required as well.

L3010

Foot, insert, removable, molded to patient model, longitudinal arch support, each:

This type of device is custom fabricated from a three-dimensional model of the patient’s foot (e.g., cast, foam impression, or virtual true 3-D digital image). This type of orthotic is an accommodative/functional device that has a heel cup of less than 10 mm and is intended to control the forefoot through a longitudinal arch support. It may also have intrinsic or extrinsic posts designed to control foot motion. This device is made of a sufficiently rigid material to reduce pathological forces. HCPCS code L3010 includes additions such as postings, padded top covers, soft tissue supplements, balance padding, and lesion or structure accommodations. Other additions may be required as well.

L3020

Foot insert, removable, molded to patient model, longitudinal/metatarsal support, each:

This type of device is custom fabricated from a three-dimensional model of the patient’s foot (e.g., cast, foam impression, or virtual true 3-D digital image). This type of orthotic is an accommodative/functional device that has a heel cup of less than 10 mm and is intended to control the forefoot through a Longitudinal Arch and metatarsal support. It may also have intrinsic or extrinsic posts designed to control foot motion. This device is made of a sufficiently rigid material to reduce pathological forces. HCPCS code L3020 includes additions such as postings, padded top covers, soft tissue supplements, balance padding, and lesion or structure accommodations. Other additions may be required as well. *This code most closely resembles Foot Levelers’ Functional Orthotics.

L3030

Foot insert, removable, formed to patient foot, each:

This type of device is custom formed directly to the patient’s foot through the use of an external heat source. The heat source should sufficiently and permanently alter the shape of the device, activating a resin, or other method by which the shape of the device is sufficiently and permanently altered to provide continuous contact with the unique characteristics of the plantar aspect of the patient’s foot. It may also have an intrinsic or extrinsic post designed to control foot motion. This type of orthotic is an accommodative functional device. This device is made of sufficiently rigid material to control foot motion and or reduce pathological forces. HCPCS code L3030 includes additions such as postings, padded top covers, soft tissue supplements, balance padding, and lesion or structure accommodations. Other additions may be required as well.

The preceding coding language has been approved by the American Podiatric Medical Association (APMA), American Orthotic and Prosthetic Association (AOPA), and Pedorthic Footcare Association (PFA) after a series of meetings, the most recent having occurred on May 13, 2016.

*L-Code Foot Orthotic Clarification Participating Organizations: American Orthotic and Prosthetic Association (AOPA) American Podiatric Medical Association (APMA) Pedorthic Footcare Association (PFA)