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    v1.0.28
    OpenPayerBilling CodesOrthotic Procedures and servicesHCPCS hcpcs-l3206-orthopedic-hightop-shoe-child-supinator-pronator
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    HCPCS L3206: Orthopedic high-top shoe with supinator/pronator, child

    HCPCS Level II code L3206 describes an orthopedic high‑top shoe for a child with a supinator or pronator insert, classified as a durable medical equipment orthotic device intended to provide foot and ankle support and alignment; service type: custom orthopedic shoe/orthotic, typical site of service: outpatient orthotics/prosthetics clinic or specialty pediatric orthotic supplier.

    For related coverage guidance, see recent payer policy updates: Interferential Stimulation Devices (for home use), Prior Authorization for Durable Medical Equipment (DME), Breast Pumps.

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    Clinical & Coding Specifications

    Clinical Context

    A child (typically aged 3–12 years) with symptomatic foot instability or malalignment is evaluated in a pediatric orthopedics or pediatric podiatry clinic. The patient presents with symptoms such as in-toeing, frequent ankle sprains, persistent pronation or supination of the foot, or gait abnormalities interfering with function or footwear. Clinical assessment includes history, physical exam focusing on foot and ankle alignment, ligamentous laxity, and gait observation. Weight-bearing radiographs of the foot and ankle may be obtained when structural deformity is suspected.

    When conservative measures (shoe inserts, physical therapy, activity modification) fail to control symptoms or when structural supination/pronation requires durable support, an orthopedic high-top shoe with supinator or pronator correction for a child is ordered and fitted. The orthotics/prosthetics clinic or pediatric orthotics technician obtains measurements, documents the prescription (including indication, shoe size, laterality, and any custom modifications), and arranges fabrication or selects a prefabricated L3206 device. The provider documents medical necessity, expected functional benefit, and any prior conservative treatments. Follow-up includes assessment of fit, skin integrity, gait improvement, and function, typically within 2–6 weeks after delivery and periodically thereafter.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99213Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutesUsed for the clinic visit where evaluation, prescription, and documentation of medical necessity for L3206 are completed
    99203Office or other outpatient visit for the evaluation and management of a new patient, typically 30 minutesUsed when a new patient is evaluated and a new prescription for the orthopedic shoe is written
    97760Orthotic management and training, initial device(s), upper or lower extremity; fitting and trainingUsed when the clinician or orthotist provides fitting and patient/caregiver training for the newly furnished orthopedic shoe
    99070Supplies and materials provided by the physician over and above those usually included with the office visitUsed if additional custom materials or modifications are supplied at the time of fitting and must be separately reported
    73540Radiologic examination, ankle; 3 viewsUsed when weight-bearing or standard radiographs of the ankle are obtained as part of structural assessment prior to prescription

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    8PModifier 8P—Performance Measure Reporting Modifier – Action Not Performed, Reason Not Otherwise Specified— is appended only to CPT Category II quality-reporting codes to indicate that the specified…- Use modifier -8P only with CPT Category II codes when the quality-measure action was not performed for an eligible patient and there is no documented reason in the medical record for omitting the…
    P6Modifier P6 indicates a declared brain‑dead patient whose organs are being removed for donor purposes. It is part of the Anesthesia Physical Status Modifiers (P1–P6) and corresponds to ASA VI. The…- When to use: Append CPT modifier P6 to anesthesia codes in the 00100–01999 range when the anesthesia provider documents a declared brain‑dead patient whose organs are being removed for donor…
    27Modifier 27 indicates a separate, subsequent outpatient hospital E/M service provided to the same patient on the same date by a different provider in a hospital outpatient setting. It is a…- Use modifier -27 on facility (hospital outpatient/ambulatory service center) claims to report a subsequent, separate, and distinct outpatient E/M service provided to the same patient on the same…
    90Modifier ‑90 (Reference/Outside Laboratory) indicates that a laboratory test was performed by an entity other than the treating or reporting provider. The American Medical Association defines…- Use CPT modifier -90 when a laboratory test is performed by an outside/reference laboratory (an entity other than the treating or reporting physician or qualified professional) and the claim needs…
    53Modifier 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…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    2080P0206XPediatric Gastroenterology PhysicianA pediatrician who specializes in the diagnosis and treatment of diseases of the digestive systems of infants, children and adolescents. This speciali…
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    332B00000XDurable Medical Equipment & Medical SuppliesA supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for…
    2086S0102XSurgical Critical Care PhysicianA surgeon with expertise in the management of the critically ill and postoperative patient, particularly the trauma victim, who specializes in critica…
    204C00000XSports Medicine (Neuromusculoskeletal Medicine) PhysicianA Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine physician trained to be responsible for the continuous care in the field of spor…
    213E00000XPodiatristA podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that l…
    177F00000XLodging ProviderA public or privately owned facility providing overnight lodging to individuals traveling long distances or receiving prolonged outpatient medical ser…
    363A00000XPhysician AssistantA physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and…

    Related Payer Policy Updates

    Specialty: Durable Medical Equipment (DME)1 / 3

    10 rows

    PolicyPayerEffective Date
    Interferential Stimulation Devices (for home use)Moda Health2026-10-01
    Prior Authorization for Durable Medical Equipment (DME)Blue Cross Blue Shield - Rhode Island2026-10-01
    Breast PumpsModa Health2026-09-01
    Personal Emergency Response SystemsCareSource Georgia2026-09-01
    Continuous Passive Motion (CPM) DevicesCigna2026-08-15
    Push-Rim Activated Power-Assist Device (E0986) — Manual Wheelchair Accessorymoda_health_plan_inc2026-08-13
    Beds and Mattresses (for Ohio Only)Colorado Rocky Mountain Health Plans2026-08-01
    Beds and Mattresses (for Kentucky Only)UnitedHealthcare2026-08-01
    Pneumatic Compression Devices (for Nebraska Only)UnitedHealthcare2026-08-01
    Indications for Coverage — Hospital beds, support surfaces, and safety enclosure beds (DME)Colorado Rocky Mountain Health Plans2026-08-01

    Related Codes

    HCPCS-L0112-CRANIAL-CERVICAL-ORTHOSIS-CONGENITAL-TORTICOLLIS-CUSTOM

    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

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    Frequently Asked Questions

    References

    1. 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. 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. 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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