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    v1.0.28
    OpenPayerBilling CodesOrthotic Procedures and servicesHCPCS hcpcs-l3650-shoulder-figure-of-eight-abduction-restrainer-ots
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    HCPCS Level II L3650: Shoulder Orthosis, Figure-of-Eight Abduction Restrainer

    HCPCS Level II code L3650 describes a prefabricated, off-the-shelf shoulder orthosis in a figure-of-eight design that functions as an abduction restrainer, used to limit shoulder motion and support the clavicular/scapular region; the service is provision of a durable medical equipment orthotic device and the typical site of service is outpatient clinic, durable medical equipment supplier, or ambulatory care setting where off-the-shelf orthoses are fitted and dispensed.

    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 patient presents to an outpatient orthopedic clinic after an acute shoulder injury sustained during a fall from standing. The clinician documents shoulder pain, anterior instability, and limited abduction due to discomfort. Examination and plain radiographs exclude fracture but suggest soft-tissue injury and suspected acromioclavicular sprain or glenohumeral subluxation. The provider elects to fit a prefabricated figure-of-eight shoulder orthosis (abduction restrainer) billed as L3650 to restrict scapulothoracic and glenohumeral motion, promote immobilization of the shoulder girdle, and reduce pain while soft tissues heal.

    The clinical workflow: the orthopedic clinician or qualified durable medical equipment (DME) supplier evaluates indications, documents medical necessity (diagnosis, functional limitation, prior conservative measures), fits the off-the-shelf device, provides patient instructions for wear and skin care, and records the item and service details in the chart. The DME supplier completes delivery, documents the specific device model and size, and submits the claim for L3650 with appropriate modifier(s) and the treating provider taxonomy and diagnosis code(s). Follow-up occurs in clinic to reassess healing and need for continued immobilization or transition to rehabilitation.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99070Supplies and materials (e.g., other than routinely included with the office visit)Used to bill for additional non-implant supplies associated with fitting an orthosis when not included in office visit
    99213Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutesCommon E/M level for follow-up visits where device selection, fitting, and reassessment occur
    29130Application of shoulder immobilizer; initial applicationPerformed when a clinician applies or adjusts a shoulder immobilizer device in clinic
    20550Injection(s); single tendon sheath, or ligament, or trigger point (if indicated)May be performed in the same visit for concomitant pain management prior to fitting
    73630Radiologic examination, shoulder; complete, minimum of three viewsOften obtained before dispensing L3650 to rule out fracture or dislocation

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    59Modifier 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…
    52Modifier ‑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…
    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…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    96Modifier 96 is appended to CPT codes to indicate that a service or procedure was provided for habilitative purposes — i.e., to help a patient learn, maintain, or improve skills and functioning for…- Use modifier -96 when a procedure or service that could be either habilitative or rehabilitative is provided specifically for habilitative purposes — i.e., to help a patient learn, maintain, or…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    3336C0002XClinic PharmacyA pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision o…
    207R00000XInternal Medicine PhysicianA physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
    2084P0800XPsychiatry PhysicianA Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
    246XS1301XSonography Specialist/Technologist CardiovascularA cardiovascular sonography technologist operates special equipment to create images and conduct tests of the cardiovascular system. They work with ph…
    133NN1002XNutrition Education NutritionistDietary & Nutritional Service Providers · Nutritionist
    261QP0905XState or Local Public Health Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    2080P0206XPediatric Gastroenterology PhysicianA pediatrician who specializes in the diagnosis and treatment of diseases of the digestive systems of infants, children and adolescents. This speciali…
    2251H1300XHuman Factors Physical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers · Physical Therapist

    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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