HCPCS Level II L3961: Shoulder Cap Orthosis, Custom Fabricated

HCPCS Level II code L3961 describes a shoulder-elbow-wrist-hand orthosis with a shoulder cap design, custom fabricated without joints and may include a soft interface, straps, and fitting/adjustment; this represents a custom upper-extremity orthotic device used for immobilization or support following injury, surgery, or for chronic shoulder conditions. Service type: orthotic fabrication and fitting. Typical site of service: outpatient orthotics/prosthetics clinic, hospital outpatient department, or specialty rehabilitation center.

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HCPCS Level II L3961: Shoulder Cap Orthosis, Custom Fabricated

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Get alerted when payer policies referencing L3961 are released or updated.

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Clinical & Coding Specifications

Clinical Context

A 62-year-old right-hand dominant patient presents after a fall onto the outstretched arm with persistent shoulder pain, weakness of shoulder abduction, and increased anterior shoulder instability. Examination and imaging identify rotator cuff tendinopathy with partial-thickness tear and symptomatic glenohumeral instability. Nonoperative management is selected with prescription of a custom-fabricated shoulder cap orthosis to immobilize and support the shoulder girdle while allowing limited elbow and wrist movement. The orthotist measures the patient, performs custom fabrication of the L3961 shoulder elbow wrist hand orthosis (shoulder cap design, without joints), and provides fitting and immediate adjustment during the same visit. The patient receives instruction on wearing schedule, skin checks, and follow-up with the orthotist for further adjustments. Typical clinical workflow: physician documents medical necessity and diagnosis (e.g., rotator cuff tear, shoulder instability), writes an order specifying custom shoulder orthosis; patient visits orthotics clinic for measurement and custom fabrication; on delivery visit, orthotist fits the device, performs adjustments, documents coding L3961, and communicates device parameters to the referring physician. Usual site of service: outpatient orthotics/prosthetics clinic or hospital outpatient department; procedure may occasionally occur in an inpatient rehabilitation setting for post‑operative immobilization.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97760`	Orthotic(s) management and training; initial encounter	Often billed by therapists for patient training and functional use instruction after delivery of the `L3961` orthosis
`97763`	Orthotic/prosthetic follow‑up management, established patient	Used for follow‑up visits to assess fit, skin integrity, and make adjustments after the orthosis is delivered
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	Common physician visit code when the clinician documents ongoing care, orders the orthosis, and reviews progress
`20610`	Aspiration and/or injection of a major joint or bursa (e.g., shoulder)	May be performed prior to orthosis prescription when diagnostic or therapeutic injection is part of nonoperative management
`99070`	Supplies and materials (e.g., additional padding or interface materials)	Used by supplier to bill nonstandard materials or supplies provided with custom fabrication

Related Modifiers

5 rows

Modifier	Description	When to Use
52	Modifier ‑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…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
22	Modifier –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…
59	Modifier 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…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
225100000X	Physical Therapist	Physical therapists (PTs) are licensed health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who…
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
231H00000X	Audiologist	(1) A specialist in evaluation, habilitation and rehabilitation of those whose communication disorders center in whole or in part in hearing function.…
111NP0017X	Pediatric Chiropractor	The Pediatric Chiropractor is a chiropractor with specialized, advanced training and certification in the evaluation, care and management of health an…
103TC2200X	Clinical Child & Adolescent Psychologist	A psychologist who develops and applies scientific knowledge to the delivery of psychological services to infants, toddlers, children and adolescents …
2085R0205X	Radiological Physics Physician	A radiological physicist deals with the diagnostic and therapeutic applications of roentgen rays, gamma rays from sealed sources, ultrasonic radiation…
172P00000X	Naprapath	Naprapathy means a branch of medicine that focuses on the evaluation and treatment of neuron-muscular conditions. Doctors of naprapathy are connectiv…

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

Frequently Asked Questions

References

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.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.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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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97760`	Orthotic(s) management and training; initial encounter	Often billed by therapists for patient training and functional use instruction after delivery of the `L3961` orthosis
`97763`	Orthotic/prosthetic follow‑up management, established patient	Used for follow‑up visits to assess fit, skin integrity, and make adjustments after the orthosis is delivered
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	Common physician visit code when the clinician documents ongoing care, orders the orthosis, and reviews progress
`20610`	Aspiration and/or injection of a major joint or bursa (e.g., shoulder)	May be performed prior to orthosis prescription when diagnostic or therapeutic injection is part of nonoperative management
`99070`	Supplies and materials (e.g., additional padding or interface materials)	Used by supplier to bill nonstandard materials or supplies provided with custom fabrication

Related Modifiers

5 rows

Modifier	Description	When to Use
52	Modifier ‑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…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
22	Modifier –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…
59	Modifier 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…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
225100000X	Physical Therapist	Physical therapists (PTs) are licensed health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who…
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
231H00000X	Audiologist	(1) A specialist in evaluation, habilitation and rehabilitation of those whose communication disorders center in whole or in part in hearing function.…
111NP0017X	Pediatric Chiropractor	The Pediatric Chiropractor is a chiropractor with specialized, advanced training and certification in the evaluation, care and management of health an…
103TC2200X	Clinical Child & Adolescent Psychologist	A psychologist who develops and applies scientific knowledge to the delivery of psychological services to infants, toddlers, children and adolescents …
2085R0205X	Radiological Physics Physician	A radiological physicist deals with the diagnostic and therapeutic applications of roentgen rays, gamma rays from sealed sources, ultrasonic radiation…
172P00000X	Naprapath	Naprapathy means a branch of medicine that focuses on the evaluation and treatment of neuron-muscular conditions. Doctors of naprapathy are connectiv…

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

Frequently Asked Questions

References

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.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.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.

OpenPayer

HCPCS Level II L3961: Shoulder Cap Orthosis, Custom Fabricated

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OpenPayer

HCPCS Level II L3961: Shoulder Cap Orthosis, Custom Fabricated

Sign up for hcpcs L3961 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

HCPCS Level II L3961: Shoulder Cap Orthosis, Custom Fabricated

Sign up for hcpcs L3961 policy alerts

HCPCS Level II L3961: Shoulder Cap Orthosis, Custom Fabricated

Sign up for hcpcs L3961 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does HCPCS code L3961 represent and where is this service typically delivered?

Which modifiers are relevant when billing L3961?

What is the typical clinical and billing workflow for providing an L3961 orthosis?

What CPT codes are commonly associated with services around L3961 delivery and follow‑up?

Which diagnoses in the provided material support medical necessity for an L3961 orthosis?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does HCPCS code L3961 represent and where is this service typically delivered?

Which modifiers are relevant when billing L3961?

What is the typical clinical and billing workflow for providing an L3961 orthosis?

What CPT codes are commonly associated with services around L3961 delivery and follow‑up?

Which diagnoses in the provided material support medical necessity for an L3961 orthosis?

References