HCPCS L2116: Ankle–Foot Fracture Orthosis, Rigid, Prefabricated

HCPCS Level II code L2116 describes a prefabricated rigid ankle–foot orthosis intended as a tibial/ankle fracture orthosis, provided with fitting and adjustment; service type is fracture orthosis fabrication and delivery and typical site of service is outpatient orthotics/prosthetics clinic, durable medical equipment supplier, or ambulatory clinic where the device is fitted and adjusted for fracture stabilization.

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HCPCS L2116: Ankle–Foot Fracture Orthosis, Rigid, Prefabricated

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Clinical & Coding Specifications

Clinical Context

A patient is seen in an orthopedic clinic after a closed tibial shaft fracture is diagnosed following a fall. The patient is an adult ambulatory individual with localized pain, swelling, and radiographic confirmation of a nondisplaced or minimally displaced tibial fracture involving the distal third of the tibia and/or associated ankle structures. The treating clinician determines conservative management with immobilization is appropriate and selects a prefabricated rigid ankle foot orthosis designed as a tibial fracture orthosis.

The clinical workflow: initial evaluation and imaging in clinic or the emergency department; diagnosis confirmed with ICD-10 fracture code(s); order for a prefabricated rigid ankle foot orthosis (HCPCS L2116) placed in clinic or orthotics department; fitting and adjustment performed by the orthotist or trained clinical staff; patient education on weight-bearing status and follow-up arranged for wound check, repeat radiographs, and potential device modification. Documentation includes the diagnosis, justification for orthosis, device description L2116, fitting time, adjustments performed, and functional/weight-bearing instructions.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`29515`	Application of short leg cast (below knee)	Alternative immobilization; may be performed instead of `L2116` for tibial fractures
`99456`	Work-related or medical disability evaluation (other than initial evaluation)	Used when functional or disability assessment is required during fracture management
`97001`	Orthotic management and training; initial fitting and training	Frequently billed for orthotic fitting and patient education when performed by qualified clinicians
`99070`	Supplies and materials (e.g., orthotic supplies)	Used to report additional non-covered supplies or materials associated with device fitting
`73630`	Radiologic exam, ankle; 3+ views	Common imaging performed before and during follow-up to assess fracture alignment and healing

Related Modifiers

5 rows

Modifier	Description	When to Use
50	Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…	- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207K00000X	Allergy & Immunology Physician	An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
333600000X	Pharmacy	A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative servi…
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
207T00000X	Neurological Surgery Physician	A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and reh…
364SC2300X	Chronic Care Clinical Nurse Specialist	Physician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
207SG0201X	Clinical Genetics (M.D.) Physician	A clinical geneticist demonstrates competence in providing comprehensive diagnostic, management and counseling services for genetic disorders.
261QM0850X	Adult Mental Health Clinic/Center	An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disord…
193400000X	Single Specialty Group	A business group of one or more individual practitioners, all of who practice with the same area of specialization.

Related Payer Policy Updates

Specialty: Durable Medical Equipment (DME)1 / 3

10 rows

Policy	Payer	Effective Date
Prior Authorization for Durable Medical Equipment (DME)	Blue Cross Blue Shield - Rhode Island	2026-10-01
Continuous Passive Motion (CPM) Devices	Cigna	2026-08-15
Push-Rim Activated Power-Assist Device (E0986) — Manual Wheelchair Accessory	moda_health_plan_inc	2026-08-13
Beds and Mattresses (for Ohio Only)	Colorado Rocky Mountain Health Plans	2026-08-01
Beds and Mattresses (for Kentucky Only)	UnitedHealthcare	2026-08-01
Pneumatic Compression Devices (for Nebraska Only)	UnitedHealthcare	2026-08-01
Indications for Coverage — Hospital beds, support surfaces, and safety enclosure beds (DME)	Colorado Rocky Mountain Health Plans	2026-08-01
Pediatric Gait Trainers and Standing Systems (for Tennessee Only)	UnitedHealthcare	2026-08-01
Enteral Nutrition (Oral and Tube Feeding) (for Pennsylvania Only)	UnitedHealthcare	2026-08-01
Beds and Mattresses (for Kansas Only)	UnitedHealthcare	2026-08-01

HCPCS L0112: Cranial Cervical Orthosis, Congenital Torticollis Type

HCPCS-L0113-CRANIAL-CERVICAL-ORTHOSIS-TORTICOLLIS

HCPCS Level II L0113: Prefabricated Cranial Cervical Orthosis for Torticollis

HCPCS-L0130-CERVICAL-FLEXIBLE-THERMOPLASTIC-COLLAR-MOLDED-TO-PATIENT

HCPCS Level II L0130: Cervical Flexible Thermoplastic Collar, Molded to Patient

HCPCS-L0140-CERVICAL-SEMI-RIGID-ADJUSTABLE-PLASTIC-COLLAR

HCPCS Level II L0140: Cervical Semi-Rigid Adjustable Plastic Collar

HCPCS-L0150-CERVICAL-SEMI-RIGID-ADJUSTABLE-CHIN-CUP

HCPCS Level II L0150: Cervical Semi-Rigid Adjustable Chin Cup

HCPCS-L0160-CERVICAL-SEMI-RIGID-OCCIPITAL-MANDIBULAR-SUPPORT

HCPCS Level II L0160: Cervical Semi-Rigid Occipital/Mandibular Support

HCPCS-L0170-CERVICAL-COLLAR-MOLDED-TO-PATIENT-MODEL

HCPCS Level II L0170: Cervical Collar, Custom-Molded

HCPCS-L0172-CERVICAL-COLLAR-SEMI-RIGID-THERMOPLASTIC-FOAM

HCPCS L0172: Cervical Collar, Semi-Rigid Prefabricated

HCPCS-L0174-CERVICAL-COLLAR-SEMI-RIGID-THORACIC-EXTENSION

HCPCS L0174: Cervical Collar, Semi-Rigid Thermoplastic with Thoracic Extension

HCPCS-L0180-CERVICAL-MULTIPLE-POST-COLLAR-OCCIPITAL-MANDIBULAR-ADJUSTABLE

HCPCS Level II L0180: Cervical Orthosis with Occipital/Mandibular Supports

Showing 1–10 of 466

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`29515`	Application of short leg cast (below knee)	Alternative immobilization; may be performed instead of `L2116` for tibial fractures
`99456`	Work-related or medical disability evaluation (other than initial evaluation)	Used when functional or disability assessment is required during fracture management
`97001`	Orthotic management and training; initial fitting and training	Frequently billed for orthotic fitting and patient education when performed by qualified clinicians
`99070`	Supplies and materials (e.g., orthotic supplies)	Used to report additional non-covered supplies or materials associated with device fitting
`73630`	Radiologic exam, ankle; 3+ views	Common imaging performed before and during follow-up to assess fracture alignment and healing

Related Modifiers

5 rows

Modifier	Description	When to Use
50	Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…	- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207K00000X	Allergy & Immunology Physician	An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
333600000X	Pharmacy	A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative servi…
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
207T00000X	Neurological Surgery Physician	A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and reh…
364SC2300X	Chronic Care Clinical Nurse Specialist	Physician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
207SG0201X	Clinical Genetics (M.D.) Physician	A clinical geneticist demonstrates competence in providing comprehensive diagnostic, management and counseling services for genetic disorders.
261QM0850X	Adult Mental Health Clinic/Center	An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disord…
193400000X	Single Specialty Group	A business group of one or more individual practitioners, all of who practice with the same area of specialization.

Related Payer Policy Updates

Specialty: Durable Medical Equipment (DME)1 / 3

10 rows

Policy	Payer	Effective Date
Prior Authorization for Durable Medical Equipment (DME)	Blue Cross Blue Shield - Rhode Island	2026-10-01
Continuous Passive Motion (CPM) Devices	Cigna	2026-08-15
Push-Rim Activated Power-Assist Device (E0986) — Manual Wheelchair Accessory	moda_health_plan_inc	2026-08-13
Beds and Mattresses (for Ohio Only)	Colorado Rocky Mountain Health Plans	2026-08-01
Beds and Mattresses (for Kentucky Only)	UnitedHealthcare	2026-08-01
Pneumatic Compression Devices (for Nebraska Only)	UnitedHealthcare	2026-08-01
Indications for Coverage — Hospital beds, support surfaces, and safety enclosure beds (DME)	Colorado Rocky Mountain Health Plans	2026-08-01
Pediatric Gait Trainers and Standing Systems (for Tennessee Only)	UnitedHealthcare	2026-08-01
Enteral Nutrition (Oral and Tube Feeding) (for Pennsylvania Only)	UnitedHealthcare	2026-08-01
Beds and Mattresses (for Kansas Only)	UnitedHealthcare	2026-08-01

HCPCS L0112: Cranial Cervical Orthosis, Congenital Torticollis Type

HCPCS-L0113-CRANIAL-CERVICAL-ORTHOSIS-TORTICOLLIS

HCPCS Level II L0113: Prefabricated Cranial Cervical Orthosis for Torticollis

HCPCS-L0130-CERVICAL-FLEXIBLE-THERMOPLASTIC-COLLAR-MOLDED-TO-PATIENT

HCPCS Level II L0130: Cervical Flexible Thermoplastic Collar, Molded to Patient

HCPCS-L0140-CERVICAL-SEMI-RIGID-ADJUSTABLE-PLASTIC-COLLAR

HCPCS Level II L0140: Cervical Semi-Rigid Adjustable Plastic Collar

HCPCS-L0150-CERVICAL-SEMI-RIGID-ADJUSTABLE-CHIN-CUP

HCPCS Level II L0150: Cervical Semi-Rigid Adjustable Chin Cup

HCPCS-L0160-CERVICAL-SEMI-RIGID-OCCIPITAL-MANDIBULAR-SUPPORT

HCPCS Level II L0160: Cervical Semi-Rigid Occipital/Mandibular Support

HCPCS-L0170-CERVICAL-COLLAR-MOLDED-TO-PATIENT-MODEL

HCPCS Level II L0170: Cervical Collar, Custom-Molded

HCPCS-L0172-CERVICAL-COLLAR-SEMI-RIGID-THERMOPLASTIC-FOAM

HCPCS L0172: Cervical Collar, Semi-Rigid Prefabricated

HCPCS-L0174-CERVICAL-COLLAR-SEMI-RIGID-THORACIC-EXTENSION

HCPCS L0174: Cervical Collar, Semi-Rigid Thermoplastic with Thoracic Extension

HCPCS-L0180-CERVICAL-MULTIPLE-POST-COLLAR-OCCIPITAL-MANDIBULAR-ADJUSTABLE

HCPCS Level II L0180: Cervical Orthosis with Occipital/Mandibular Supports

Showing 1–10 of 466

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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HCPCS L2116: Ankle–Foot Fracture Orthosis, Rigid, Prefabricated

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HCPCS L2116: Ankle–Foot Fracture Orthosis, Rigid, Prefabricated

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

References

HCPCS L2116: Ankle–Foot Fracture Orthosis, Rigid, Prefabricated

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HCPCS L2116: Ankle–Foot Fracture Orthosis, Rigid, Prefabricated

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

What does HCPCS L2116 represent and what services are included?

Which modifiers should be used with L2116 and when?

In what clinical scenarios and workflow is L2116 commonly used?

Which related CPT codes are commonly associated with services for patients receiving L2116?

Which payers are covered and does the page provide specific coverage or reimbursement rates?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

What does HCPCS L2116 represent and what services are included?

Which modifiers should be used with L2116 and when?

In what clinical scenarios and workflow is L2116 commonly used?

Which related CPT codes are commonly associated with services for patients receiving L2116?

Which payers are covered and does the page provide specific coverage or reimbursement rates?

References