HCPCS L1700: Legg Perthes Orthosis (Toronto Type), Custom Fabricated - OpenPayer

Summary & Overview

HCPCS L1700: Legg Perthes Orthosis (Toronto Type), Custom Fabricated

HCPCS Level II code L1700 represents a custom-fabricated Legg Perthes orthosis (Toronto type), an orthotic device used to support and position the hip in patients with Legg-Calvé-Perthes disease or comparable pediatric hip disorders. Nationally, this code matters because it captures durable medical equipment (DME) services that involve custom fabrication and orthotist expertise, which have implications for coverage policies, prior authorization practices, and reimbursement for pediatric orthotic care.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of billing context for L1700, typical clinical settings and service types, and what to expect when this orthosis is billed. The publication outlines common benchmarks and payer approaches to custom orthoses, summarizes relevant policy considerations affecting authorization and documentation, and provides clinical context for when a Toronto-style Legg Perthes orthosis is used.

This summary is intended for national audiences involved in billing, orthotics fabrication, pediatric orthopedics, and payer policy, offering clear orientation to L1700 and the administrative contours that affect access to custom hip orthoses.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareL1700HCPCS Level IIorthoticsLegg Perthespediatric orthosisdurable medical equipmentcustom fabricatedorthotics billing

Billing Code Overview

HCPCS Level II code L1700 describes a Legg Perthes orthosis (Toronto type), custom fabricated. This device is a custom-made lower-extremity orthosis designed to support the hip and femoral head in patients with Legg-Calvé-Perthes disease or similar hip pathology.

Service type: Orthotic device fabrication and fitting

Typical site of service: Orthotics/prosthetics clinic, pediatric orthopedics clinic, or outpatient specialty clinic

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 6‑ to 12‑year‑old child diagnosed with Legg‑Calvé‑Perthes disease presents to a pediatric orthopedist for management of femoral head containment. After clinical assessment and radiographs confirm lateralization or collapse of the femoral head, the orthopedist prescribes a custom fabricated Toronto‑style Legg‑Perthes orthosis to maintain abduction and containment during the healing phase. The workflow: initial orthopedic evaluation and imaging, casting or scanning of the pelvis/hips for custom fabrication, delivery and fitting appointment with orthotist, caregiver education on wear schedule and skin care, periodic follow‑ups every 6–12 weeks to assess fit and radiographic progress, and adjustments or refabrication as the child grows or as clinical course dictates. Typical site of service: outpatient orthopedic clinic, pediatric orthotics clinic, or ambulatory durable medical equipment (DME) facility, with fabrication performed by a certified orthotist in a DME or prosthetics/orthotics lab.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — standard reporting	Use when no special circumstances apply.
`11`	Primary procedure

HCPCS L3973: Shoulder-Elbow-Wrist-Hand Orthosis, Abduction (Airplane) Design

HCPCS-L3201-ORTHOPEDIC-INFANT-OXFORD-SUPINATOR-PRONATOR-SHOE

HCPCS L3201: Orthopedic Infant Oxford Shoe with Supinator or Pronator

HCPCS-L0631-LUMBAR-SACRAL-ORTHOSIS-SAGITTAL-CONTROL

HCPCS Level II L0631: Lumbar-Sacral Orthosis, Sagittal Control

HCPCS-L3214-BENESCH-BOOT-PAIR-JUNIOR

HCPCS L3214: Benesch Boot, Pair, Junior

HCPCS-L3330-LIFT-ELEVATION-METAL-EXTENSION-SKATE

HCPCS L3330: Lift, Elevation Metal Extension (Skate)

HCPCS-L3960-SHOULDER-ELBOW-WRIST-HAND-ORTHOSIS-ABDUCTION-AIRPLANE-PREFAB

HCPCS L3960: Shoulder-Elbow-Wrist-Hand Orthosis, Abduction Airplane, Prefabricated

HCPCS-L2070-HKAFO-TORSION-CONTROL-CUSTOM-FABRICATED

HCPCS L2070: Hip-Knee-Ankle-Foot Orthosis, Torsion Control, Custom Fabricated

HCPCS-L2526-LOWER-EXTREMITY-THIGH-ISCHIAL-CONTAINMENT-CUSTOM-FITTED

HCPCS L2526: Lower Extremity Thigh Prosthetic Addition, Ischial Containment

HCPCS-L2200-LOWER-EXTREMITY-LIMITED-ANKLE-MOTION-ADDITION

HCPCS L2200: Addition to Lower Extremity for Limited Ankle Motion

HCPCS-L2620-LOWER-EXTREMITY-PELVIC-CONTROL-HIP-JOINT-HEAVY-DUTY

HCPCS L2620: Lower Extremity Orthotic Addition, Pelvic Control Hip Joint

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Taxonomy Code	Specialty	Notes
`2080P0207X`	Orthopedic Surgery	Pediatric and general orthopedic surgeons commonly prescribe this orthosis.
`331E00000X`	Orthotist / Prosthetist	Certified orthotists fabricate, fit, and adjust the device.
`261QM0800X`	Pediatric Medicine	Pediatricians refer and co-manage growth and developmental considerations.
`207L00000X`	Physical Medicine & Rehabilitation	PM&R physicians may prescribe and oversee nonoperative containment strategies.
`207K00000X`	Physical Therapist	Physical therapists support gait training and wear compliance during treatment.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M91.00`	Legg-Calvé-Perthes disease, unspecified hip	Primary diagnosis for which a Toronto‑type Legg‑Perthes orthosis is prescribed to provide containment.
`M91.01`	Legg-Calvé-Perthes disease, right hip	Unilateral right hip disease requiring orthotic containment and monitoring.
`M91.02`	Legg-Calvé-Perthes disease, left hip	Unilateral left hip disease requiring orthotic containment and monitoring.
`M24.551`	Contracture, right hip	Secondary limited range of motion that may necessitate custom orthotic support.
`M24.552`	Contracture, left hip	Secondary contracture contributing to altered mechanics and need for containment orthosis.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99203`	Office or other outpatient visit for the evaluation and management of a new patient, low to moderate complexity	Initial orthopedic evaluation and decision to prescribe the orthosis.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, low to moderate complexity	Follow‑up visits for fit checks, adjustments, and progress assessment.
`73502`	Radiologic examination, hip; unilateral, 2 views	Baseline and follow‑up radiographs to stage Legg‑Calvé‑Perthes disease and monitor containment.
`73504`	Radiologic examination, hip; bilateral, 2 views	Use when bilateral hip imaging is performed to evaluate disease extent.
`97763`	Orthotic management and training, upper and/or lower extremity, initial orthotic set-up and education (includes gait training)	Orthotist or therapist time for initial device training, caregiver instruction, and gait/activities training.
`99070`	Supplies and materials, non‑covered items; used during a procedure (list separately in addition to code for primary procedure)	Use for additional non‑standard supplies or materials used during fitting or modification when payer requires separate supply billing.

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