Summary & Overview
HCPCS L3671: Custom Non-Jointed Shoulder Orthosis
HCPCS Level II code L3671 designates a custom-fabricated, non-jointed shoulder orthosis that may include soft interface material and straps, and includes fitting and adjustment. As a DME classification for shoulder immobilization, this code matters nationally for post-operative care, fracture management, and chronic shoulder instability where a custom non-articulated device is clinically indicated. Proper coding affects coverage determinations, supply sourcing, and continuity of patient support across care settings.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a national overview of typical coverage considerations, billing practices, and where this device is commonly furnished.
Readers will learn the clinical context for using a custom, non-jointed shoulder orthosis, common service sites where the device is provided, and the types of documentation and billing elements that influence payer adjudication. The summary highlights benchmarks and policy-relevant factors for payers and providers, and outlines the operational steps tied to fitting and adjustment that affect billing. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code L3671 describes a shoulder orthosis with a shoulder joint design, without joints, that may include a soft interface and straps, and is custom fabricated, including fitting and adjustment. This device is intended to provide immobilization and support of the shoulder complex following injury, surgery, or for chronic instability where a non-articulated orthosis is clinically indicated.
Service type: Durable medical equipment — custom fabricated shoulder orthosis with fitting and adjustment.
Typical site of service: Outpatient orthopedic clinics, durable medical equipment (DME) providers, hospital outpatient departments, and post-acute care settings where custom orthoses are fitted and adjusted.
Clinical & Coding Specifications
Clinical Context
A 62-year-old male patient presents to an outpatient orthotics clinic after surgical repair of a massive rotator cuff tear and concurrent subacromial decompression. Postoperative orders from the orthopedic surgeon indicate immobilization and support of the shoulder to limit motion and protect the repair while allowing wound checks and dressing changes. The orthotist evaluates the patient, documents shoulder range of motion, pain level, skin integrity, and shoulder girth, and measures for a custom-fabricated shoulder orthosis. The device provided is a custom fabricated, shoulder joint design without mechanical joints, with soft interface and adjustable straps; fitting and adjustment are performed in clinic. Billing uses HCPCS Level II code L3671 for the custom shoulder orthosis. Typical workflow: preauthorization if required by the payor, patient measurement and device fabrication, in-person fitting and adjustments, documentation of medical necessity tied to the operative diagnosis and mobility restriction, and delivery with patient education. Typical sites of service include outpatient orthotics/prosthetics clinics, hospital outpatient departments, and ambulatory surgery centers for same-day fittings when ordered postoperatively. Common clinical indications include postoperative rotator cuff repair, shoulder instability requiring immobilization, proximal humerus fracture post-reduction, and severe adhesive capsulitis when rigid immobilization is indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT |