2025 HCPCS code L3960

Supply of a prefabricated shoulder, elbow, wrist, and hand orthosis (airplane design) including fitting and adjustment.

Medicare requires medical necessity for the orthosis, and the provider must appropriately document this necessity.The fitting and adjustment services are included in the code and should not be billed separately.

Modifiers may be applicable depending on the circumstances of service. Consult CMS guidelines for appropriate modifier usage.

The orthosis must be medically necessary for the treatment or improvement of the patient's condition.The provider must document the diagnosis, the rationale for using this specific orthosis, and its expected benefit to the patient's recovery.

The provider's responsibility includes selecting the appropriate prefabricated orthosis, fitting it to the patient, and adjusting it to ensure proper function and support.The provider must also document the medical necessity for the orthosis.

IMPORTANT For a similar custom-fabricated orthosis with an airplane design, report L3967. For a similar orthosis with a shoulder cap design, report L3961. For a prefabricated shoulder, elbow, wrist, and hand orthosis for a patient with Erb's palsy, report L3962.See codes L3650 to L3999 for other upper limb orthoses.

In simple words: This code covers providing and fitting a special brace that supports the arm and hand. The brace is pre-made, but a healthcare provider adjusts it to fit properly.It's used to help the arm heal after an injury or surgery.

This HCPCS code represents the provision of a single, prefabricated shoulder, elbow, wrist, and hand orthosis designed to support the arm perpendicular to the trunk ("airplane design").The code encompasses the fitting and adjustment of the orthosis by the provider. The orthosis supports the shoulder, arm, elbow, forearm, wrist, and hand, allowing free finger movement. It is prefabricated but requires provider fitting and adjustment for proper function.This orthosis may be prescribed to immobilize the upper limb in a specific orientation to aid recovery from conditions such as brachial plexus injury, nerve injury, or axillary burns to prevent contractures and deformities.

Example 1: A patient presents with a brachial plexus injury following a motor vehicle accident. The physician orders a prefabricated airplane design orthosis (L3960) to support the arm and facilitate healing and prevent contractures., A patient undergoes rotator cuff surgery. Post-operatively, the surgeon prescribes L3960 to immobilize the shoulder and arm in a specific position to promote proper healing and prevent complications., A patient sustains a severe burn injury to the axilla. To protect the healing tissues and prevent contractures, the physician orders an L3960 orthosis for immobilization and support.

* Physician's order specifying the need for the orthosis.* Documentation of the patient's diagnosis and medical necessity for the orthosis.* Detailed description of the orthosis provided (manufacturer, model, etc.).* Records of fitting and adjustment by the provider.* Evidence of patient education regarding the use and care of the orthosis.

** This code is specifically for a prefabricated orthosis. Custom-fabricated orthoses require different codes.Always verify the specific orthosis supplied matches the code description.

  • Payment Status: Active
  • Modifier TC rule: Not applicable.
  • Specialties:Orthopedics, Physical Medicine and Rehabilitation, Hand Surgery
  • Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center
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