L3960 - Coding Verification Review Requirement

Joint DME MAC & PDAC Publication

The DME MACs have noticed a substantial increase in claim submission for HCPCS code L3960 SHOULDER ELBOW WRIST HAND ORTHOSIS, ABDUCTION POSITIONING, AIRPLANE DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT.

L3960 is a prefabricated shoulder "airplane design" abduction orthosis which includes the elbow, wrist, hand, and fingers. There are adjustable rigid cuffs and joints/components to optimize the shoulder, elbow, wrist, and hand angles. Shoulder position is capable of 90 degrees abduction from torso. Adjustable rigid chest and pelvic frames or panels supports shoulder and arm components. Product is all-inclusive of soft interface and closures/straps. It is used for abducting the arm away from the body and capable of immobilizing the shoulder, elbow, wrist, and hand.

Effective for claims with dates of service on or after August 1, 2020 the only products which may be billed using code L3960 are those for which a written coding verification review has been made by the Pricing, Data Analysis, and Coding (PDAC) contractor and subsequently published on the appropriate Product Classification list.

For items containing elastic or other fabric components, suppliers are referred to the Joint DME MAC Article Correct Coding and Coverage - Braces Constructed Primarily of Elastic or Other Fabric Materials.

For questions about correct coding, contact the PDAC Contact Center at 877-735-1326 during the hours of 9:30 a.m. to 5:00 p.m. ET, Monday through Friday, or email the PDAC by completing the DME PDAC Contact Form located on the PDAC Website.