L3670 Shoulder Orthosis HCPCS Reimbursement

HCPCS Level II code L3670 denotes a prefabricated, off-the-shelf shoulder orthosis for acromioclavicular support made of canvas and webbing. This orthotic is commonly used for stabilization following AC joint sprains, mild dislocations, or postoperative protection and is widely relevant across outpatient orthopedic care and durable medical equipment supply chains. Nationally, proper coding of off-the-shelf orthoses affects device coverage, claim adjudication, and patient access to non-custom supports.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical indications tied to the device type, typical sites of service, and the payer landscape affecting coverage and billing. The publication summarizes benchmark considerations for reimbursement categories, commonly observed policy requirements for prefabricated orthoses versus custom-fitted devices, and coding nuances that influence claim acceptance.

The report is aimed at billing managers, orthopedic clinicians, DME suppliers, and policy analysts who need a concise reference on HCPCS Level II code L3670: what it represents, where it is used, and how national payers typically approach coverage and claims processing. Data not available in the input is noted where applicable.

Billing Code Overview

HCPCS Level II code L3670 describes a shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf. The code represents a factory-made shoulder support designed to stabilize the acromioclavicular joint using canvas and webbing materials and is intended for immediate fitting without custom fabrication.

Service type: Durable Medical Equipment / Orthotic Device

Typical site of service: Outpatient clinics, orthopedic specialty offices, durable medical equipment suppliers, and retail medical supply locations.

Data not available in the input.

Clinical Context

A 54-year-old patient presents to an orthopedic clinic after a fall onto the shoulder with localized pain over the acromioclavicular joint and visible prominence of the distal clavicle. The orthopedist performs a focused shoulder exam, orders radiographs confirming a low- to moderate-grade acromioclavicular (AC) joint sprain without displaced fracture, and determines the patient is appropriate for conservative management. The clinic dispenses an off-the-shelf canvas and webbing AC shoulder orthosis (L3670) to immobilize and support the acromioclavicular region. The clinical workflow includes device selection, fitting and adjustment by clinical staff, patient education on wear time and skin checks, documentation of medical necessity (exam findings, imaging, functional limitations), and coding/billing to the patient’s insurer. Follow-up is scheduled in 1–2 weeks to assess pain, function, and need for continued orthotic use or escalation of care.

Coding Specifications

Modifier	Description	When to Use
`LT`	Left side	Use when the orthosis is for the left shoulder
`RT`	Right side

Taxonomy Code	Specialty	Notes
`203K00000X`	Orthopaedic Surgery	Primary clinicians who evaluate AC joint injuries and prescribe shoulder orthoses
`173V00000X`	Physical Medicine & Rehabilitation	Specialists who manage nonoperative shoulder conditions and orthotic needs
`261QM0800X`	Physician Assistant	Clinicians who commonly fit and document orthotic provision in outpatient settings
`364S00000X`	Occupational Therapist	Provides patient education on use, skin checks, and functional training with the orthosis

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S43.011A`	Superior glenoid labrum lesion of right shoulder, initial encounter	AC joint injuries and adjacent shoulder soft-tissue injuries commonly coexist; orthosis provides AC support during healing
`S43.012A`	Superior glenoid labrum lesion of left shoulder, initial encounter	Same relevance for left-sided injuries
`S43.001A`	Unspecified dislocation of right shoulder joint, initial encounter	Shoulder stabilization with an AC orthosis may be used in select nonoperative cases
`S43.002A`	Unspecified dislocation of left shoulder joint, initial encounter	Same relevance for left-sided cases
`S43.121A`	Sprain of acromioclavicular joint of right shoulder, initial encounter	Directly indicates AC joint sprain — primary indication for `L3670`
`S43.122A`	Sprain of acromioclavicular joint of left shoulder, initial encounter	Left-sided AC sprain indication
`M24.211`	Recurrent dislocation, right shoulder	Orthosis used for temporary stabilization during conservative management
`M75.11`	Complete rotator cuff tear or rupture of right shoulder, not specified as traumatic	May accompany AC pathology; orthosis used for comfort/support in some nonoperative pathways

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`73030`	Radiologic examination, shoulder; complete, minimum of two views	Often performed at initial visit to evaluate AC joint injury before prescribing `L3670`
`99213`	Office or other outpatient visit for evaluation and management of an established patient, typically 15 minutes	Common E/M code used for follow-up visits to assess pain and orthosis effectiveness
`99203`	Office or other outpatient visit for a new patient, typically 30 minutes	Common E/M code used at initial evaluation when the orthosis is prescribed
`97001`	Physical therapy evaluation	May be performed before or after orthosis fitting when rehabilitation is indicated
`99070`	Supplies and materials (except spectacles), provided by the physician	Used occasionally to bill low-cost supplies or additional padding provided with the orthosis

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Summary & Overview

HCPCS L3670: Shoulder Orthosis, Acromio/Clavicular, Prefabricated Off-the-Shelf