2025 HCPCS code L3967

Shoulder, elbow, wrist, and hand orthosis, abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment.

Use L-codes to represent the supply of orthotics. These codes also cover fitting and adjustment services, which should not be billed separately.

Medical necessity must be established for the use of L3967. This may involve demonstrating that the orthosis is essential for the treatment or improvement of the patient's condition, such as preventing contractures, promoting healing, or improving function.

The provider uses the device to support the patient's shoulder, arm, elbow, forearm, wrist, and hand, allowing free movement of the fingers. The orthosis is custom-designed and fitted by the provider to the patient's specific measurements and may include a soft inner lining.This device 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, preventing future joint contracture and deformities.

IMPORTANT For a prefabricated orthosis with airplane design, report L3960. For a custom fabricated orthosis with a shoulder cap design, report L3961. For a prefabricated shoulder, elbow, wrist, and hand orthosis for a patient with Erbs palsy, report L3962.

In simple words: This code covers a custom-made support for your shoulder, elbow, wrist, and hand. It's designed like an airplane wing to hold your arm out from your body. It doesn't have any joints and might have soft padding and straps.The cost includes the device itself and the fitting and adjustments made by your healthcare provider.

This code represents the supply of a single custom-made thoracic or trunk component and support bar for a shoulder, elbow, wrist, and hand orthosis that does not have joints.The device has an airplane design to support the arm in a position perpendicular to the trunk and may have a soft inner lining and straps to secure the device.The provider makes the orthosis according to the patient’s measurements. The code includes fitting and adjustment by the provider.

Example 1: A patient suffers a brachial plexus injury in a motorcycle accident, requiring immobilization of the upper limb to facilitate nerve healing. L3967 is used for the custom-made thoracic component and support bar., A patient experiences severe burns to the axilla, necessitating an orthosis to prevent contractures and maintain proper positioning during healing. L3967 is billed for the custom fabrication and fitting of the device., A child with Erb's palsy requires an abduction positioning orthosis to support the affected arm and prevent muscle shortening and joint deformities. Though L3962 would be used for prefabricated device, in this case, due to specific patient need, custom fabrication is required and L3967 is used.

Documentation should include the medical necessity for the orthosis, the type and location of the injury or condition being treated, the patient's measurements, the design of the orthosis, and the fitting and adjustment process.

  • Specialties:Orthopedics, Physical Medicine and Rehabilitation, Burn Specialists
  • Place of Service:Office, Outpatient Hospital, Inpatient Hospital (if fitted during inpatient stay)
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