Summary & Overview
HCPCS L2114: Semi-Rigid Prefabricated Tibial Fracture Ankle Foot Orthosis
HCPCS Level II code L2114 designates a prefabricated, semi-rigid ankle foot orthosis specifically for tibial or fracture-related stabilization and includes professional fitting and adjustment. This code matters nationally as it captures billing for commonly used off-the-shelf fracture orthoses that support post-injury stabilization, influence durable medical equipment utilization, and affect orthotics service reimbursement patterns across payers. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn what the code represents clinically and operationally, how it is classified within HCPCS Level II, and where the device is typically supplied and fitted. The publication summarizes expected sites of service, common service line contexts, and the implications for coverage and claims processing at a national level. It also highlights typical billing considerations and common modifiers used with orthotic DME billing. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code L2114 describes an ankle foot orthosis specified as a fracture orthosis / tibial fracture orthosis, semi-rigid, prefabricated, and includes fitting and adjustment. This device is intended to stabilize and protect the lower leg and ankle following tibial or related fractures.
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Service type: Durable medical equipment / orthotic device fitting and adjustment
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Typical site of service: Outpatient orthotics clinic, durable medical equipment provider location, hospital outpatient department, or physician office where prefabricated orthoses are fitted and adjusted
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 42-year-old male presents to an orthopedic clinic after sustaining a distal tibial/fibular fracture while playing soccer. After initial evaluation and radiographs in the emergency department, the fracture is deemed stable but requires immobilization with a prefabricated semi-rigid tibial fracture orthosis to protect the ankle and lower tibia during the early healing phase. The orthotist or durable medical equipment (DME) supplier fits the patient with an ankle-foot fracture orthosis, L2114, adjusts straps and padding for comfort, and documents sizing, fitting time, and patient education on use and skin checks. Typical clinical workflow includes referral from the treating orthopedic surgeon, measurement and selection of the prefabricated device during an outpatient DME appointment or hospital orthopedic clinic visit, verification of medical necessity with the payer, application and fitting, and scheduling of follow-up visits for wound/skin checks and radiographic reassessment. Typical site of service is outpatient orthopedic clinic, DME supplier location, or hospital outpatient department. Typical patient scenario includes acute, nonoperative tibial or distal fibular fractures, post-closed reduction stabilization when a semi-rigid prefabricated fracture orthosis is clinically appropriate, in patients ambulatory with weight-bearing status specified by the surgeon.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side |