Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerBilling CodesOrthotic Procedures and servicesHCPCS hcpcs-l3916-wrist-hand-orthosis-prefabricated
    Ask Trek AI about this page

    HCPCS L3916: Wrist-Hand Orthosis, Prefabricated

    HCPCS Level II code L3916 describes a prefabricated wrist-hand orthosis that includes one or more nontorsion joints, elastic bands or turnbuckles and may include a soft interface and straps; service type is provision of a prefabricated upper-extremity orthotic device and the typical site of service is outpatient clinics, orthotics/prosthetics offices, or durable medical equipment providers where device fitting and minor adjustments occur.

    For related coverage guidance, see recent payer policy updates: Interferential Stimulation Devices (for home use), Durable Medical Equipment (DME): Tumor Treating Fields (Alternating Electric Field Therapy) Medical Guideline, Durable Medical Equipment (DME): Bone Growth Stimulators Medical Guideline.

    Customize your policy alerts

    Sign up for hcpcs L3916 policy alerts

    Get alerted when payer policies referencing L3916 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Table of contents

    Progress1 / 7

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Clinical & Coding Specifications

    Clinical Context

    A 58-year-old right-hand dominant office worker presents to an orthotics clinic after a distal radius fracture treated conservatively with casting or following internal fixation. The patient reports persistent wrist pain, decreased grip strength, and difficulty with activities of daily living such as typing and lifting. The treating clinician (orthopedic surgeon or hand therapist) assesses range of motion, pain provocation, and functional limitations and determines a prefabricated wrist-hand orthosis is appropriate for immobilization, support, or to provide controlled motion via nontorsion joints and elastic bands.

    The clinical workflow includes: initial evaluation and diagnosis, fitting of the off-the-shelf prefabricated orthosis coded as L3916, adjustment of straps and elastic bands for comfort, instruction on wear schedule and skin care by a certified orthotist or occupational therapist, documentation of medical necessity (diagnosis, functional deficit, prior conservative measures), billing with relevant modifier(s) as indicated, and follow-up visits for reassessment, modifications, or progression to custom orthosis if needed.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    97760Orthotic management and training, initial encounter; fitting and training with durable medical equipment (e.g., orthotic device)Performed at the time of fitting to train the patient in use, donning/doffing, and care of the L3916 prefabricated wrist-hand orthosis.
    97763Orthotic/prosthetic supply and training, subsequent encounterUsed for follow-up visits providing additional orthotic training, adjustments, and functional reassessment after initial L3916 fitting.
    97530Therapeutic activities, direct (one-on-one) patient contact by the provider; each 15 minutesCommonly performed alongside orthosis provision to address functional deficits and strengthen affected upper extremity.
    99070Supplies and materials (e.g., additional padding, straps), not otherwise reportedUsed to bill non-covered expendable supplies provided with the L3916 orthosis during fitting or adjustments.
    99455Work related or medical disability examination services; evaluation of ability to return to workMay be used when the orthosis is part of a job-related functional capacity evaluation supporting return-to-work decisions.

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    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…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    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…
    P3Modifier P3 denotes that the anesthesia patient has severe systemic disease (ASA III). It applies only to anesthesia CPT codes (00100–01999) and must be appended by the anesthesia provider with…- Applies only to anesthesia procedure codes (CPT 00100–01999) and should be appended by the anesthesia provider when the patient meets the definition of "severe systemic disease" (CPT/AAPC P3;…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    207W00000XOphthalmology PhysicianAn ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically train…
    207P00000XEmergency Medicine PhysicianAn emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospit…
    207X00000XOrthopaedic Surgery PhysicianAn orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated…
    2084B0040XBehavioral Neurology & Neuropsychiatry PhysicianBehavioral Neurology & Neuropsychiatry is a medical subspecialty involving the diagnosis and treatment of neurologically based behavioral issues.
    261QS0112XOral and Maxillofacial Surgery Clinic/CenterThe specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functi…
    207RA0201XAllergy & Immunology (Internal Medicine) PhysicianAn internist doctor of osteopathy that specializes in the treatment of allergy and immunologic disorders. A doctor of osteopathy that is board eligib…
    207RS0010XSports Medicine (Internal Medicine) PhysicianAn internist trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but al…

    Related ICD-10-CM Codes

    26 rows

    ICD-10-CM CodeDescription
    G56.01Carpal tunnel syndrome, right upper limb
    G56.02Carpal tunnel syndrome, left upper limb
    G56.21Lesion of ulnar nerve, right upper limb
    G56.22Lesion of ulnar nerve, left upper limb
    M05.841Other rheumatoid arthritis with rheumatoid factor of right hand
    M06.9Rheumatoid arthritis, unspecified
    M19.041Primary osteoarthritis, right hand
    M20.21Hallux rigidus, right foot
    M20.41Other hammer toe(s) (acquired), right foot
    M24.231Disorder of ligament, right wrist

    Showing 1–10 of 26

    Related Payer Policy Updates

    Specialty: Durable Medical Equipment (DME)1 / 3

    5 rows

    PolicyPayerEffective Date
    Interferential Stimulation Devices (for home use)Moda Health2026-10-01
    Durable Medical Equipment (DME): Tumor Treating Fields (Alternating Electric Field Therapy) Medical GuidelineWPS Health Insurance2026-10-01
    Durable Medical Equipment (DME): Bone Growth Stimulators Medical GuidelineWPS Health Insurance2026-10-01
    General Durable Medical Equipment (DME) Medical GuidelineWPS Health Insurance2026-10-01
    Prior Authorization for Durable Medical Equipment (DME)Blue Cross Blue Shield - Rhode Island2026-10-01

    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

    • More pages

    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.
    Published by

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

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.