2025 HCPCS code L3961

Supply of a custom-made shoulder, elbow, wrist, and hand orthosis with a shoulder cap design, without joints; may include soft interface, straps, custom fabricated, includes fitting and adjustment.

HCPCS coding guidelines should be followed.Documentation must clearly support the medical necessity and appropriate use of the orthosis.

Modifiers may apply depending on the specific circumstances of service.Consult the most current HCPCS guidelines and payer specific instructions.

The orthosis must be medically necessary to treat or improve the function of the affected body part.Appropriate documentation is needed to support the medical necessity of the device.

The provider is responsible for assessing the patient's need for the orthosis, taking measurements, fabricating the device, fitting it to the patient, and ensuring its proper function.Post-fitting adjustments may also be included.

IMPORTANT For a similar prefabricated orthosis with an airplane design, report L3960. For a similar custom-fabricated orthosis with an airplane design, report L3967. For a prefabricated shoulder, elbow, wrist, and hand orthosis for a patient with Erbs palsy, report L3962. For other upper limb orthoses, see codes L3650 to L3999.

In simple words: This code covers the cost of a custom-made support brace for the arm and shoulder. The brace is made to fit the patient perfectly and helps support the arm and shoulder without restricting finger movement.It's often used to help heal injuries or conditions affecting the arm or shoulder.

This HCPCS code represents the supply of a custom-made shoulder, elbow, wrist, and hand orthosis (SEWHO) featuring a shoulder cap design.The orthosis is static (without joints) but may incorporate a soft inner lining and straps for secure placement. The provider fabricates the orthosis based on the patient's specific upper limb measurements.The code encompasses fitting and adjustment of the orthosis by the provider.The shoulder cap design helps maintain the anatomical alignment of the shoulder joint's bony components, protecting against subluxation. The orthosis supports the shoulder, arm, elbow, forearm, wrist, and hand, allowing for free finger movement.This orthosis may be prescribed to immobilize the upper limb in a specific position to aid recovery from conditions such as brachial plexus injury, nerve injury, or burns of the axilla.

Example 1: A patient presents with a brachial plexus injury following a motor vehicle accident. The physician orders a custom-made SEWHO (L3961) to stabilize the shoulder and facilitate healing., A patient with a severe burn injury to the axilla requires an orthosis to prevent contractures. The physician orders a custom-fabricated SEWHO (L3961) to support the arm and shoulder., A patient post-surgery for a shoulder dislocation needs support and protection. The physician prescribes a custom-made SEWHO (L3961) to help maintain the shoulder joint in proper alignment during recovery.

Detailed medical history, physical examination findings, imaging studies (if applicable) demonstrating the need for the orthosis, specifications of the custom-made orthosis (measurements, materials, design), and documentation of fitting and adjustment by the provider.

** Carrier judgment (C) may apply.The code includes fitting and adjustment; these services should not be billed separately.Medicare requires medical necessity documentation for the orthosis.

  • Revenue Code: Unknown
  • RVU: Unknown
  • Global Days : Unknown
  • Payment Status: Active
  • Modifier TC rule: Not applicable
  • Fee Schedule : Unknown
  • Specialties:Orthopedics, Physical Medicine and Rehabilitation, Occupational Therapy
  • Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center
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