HCPCS Level II L3967: Shoulder-Elbow-Wrist-Hand Abduction Positioning Orthosis

HCPCS Level II code L3967 describes a custom-fabricated shoulder-elbow-wrist-hand orthosis in an abduction positioning (airplane) design with thoracic component and support bar, provided without joints and may include soft interface, straps, fitting, and adjustment; the service is a durable medical equipment/prosthetic orthotic supply (custom orthosis fabrication and fitting) typically provided in outpatient orthopedic clinics, prosthetics/orthotics facilities, or hospital outpatient departments.

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HCPCS Level II L3967: Shoulder-Elbow-Wrist-Hand Abduction Positioning Orthosis

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Clinical & Coding Specifications

Clinical Context

A typical patient is a 45-year-old adult who sustained a proximal humerus fracture with surgical fixation and requires a custom abduction shoulder orthosis to maintain shoulder abduction and protect the repair during the early postoperative healing phase. The orthosis described by L3967 (shoulder elbow wrist hand orthosis, abduction positioning, airplane design, thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment) is provided after an orthopedic clinic or hospital consultation. Clinical workflow: the orthopedic surgeon documents the indication and orders a custom fabricated abduction orthosis; a certified orthotist evaluates the patient, performs measurements, fabricates or adjusts the device, fits and trains the patient in device use and precautions, and documents the fitting and any adjustments. Follow-up visits with the surgeon and orthotist occur for wound checks, range-of-motion guidance, progressive weaning from the orthosis, and billing is submitted to the patient’s insurer with the appropriate HCPCS code L3967 and applicable modifiers to reflect the service circumstances.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99203`	Office or other outpatient visit for the evaluation and management of a new patient, typically 30 minutes	Commonly used for the initial orthopedic evaluation and order for the custom abduction orthosis.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Used for postoperative follow-up visits where orthosis fit, wound checks, and adjustments are documented.
`97760`	Orthotic management and training, upper extremity, initial encounter, each 15 minutes	Billed by therapists for training the patient in donning, doffing, skin inspection, and functional use of the shoulder abduction orthosis.
`97001`	Physical therapy evaluation	Used when a physical therapist evaluates the patient’s rehabilitation needs related to shoulder immobilization and plans therapy while using the orthosis.
`99070`	Supplies and materials provided by the physician over and above those usually included with the office visit	May be used to bill for supplemental non-custom supplies or padding provided at the fitting appointment.

Related Modifiers

5 rows

Modifier	Description	When to Use
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…
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…
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…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

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…
363LP0808X	Psychiatric/Mental Health Nurse Practitioner	Physician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
207K00000X	Allergy & Immunology Physician	An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	A preventive medicine physician who specializes in preventive medicine/occupational-environmental medicine, which is focused on protecting the populat…
207QP0002X	Physician Nutrition Specialist (Family Medicine)	A physician who specializes in the diagnosis and treatment of primary nutritional diseases (e.g., undernutrition, overnutrition, and genetic or acquir…
207ZI0100X	Immunopathology Physician	A pathologist who specializes in the diagnosis of immunologic diseases.
3418M1110X	Military or U.S. Coast Guard Ground Transport Ambulance	Vehicle and staff for patient emergency or non-emergency ground transport. Includes traditional ambulances as well as ambulance buses.

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
`99203`	Office or other outpatient visit for the evaluation and management of a new patient, typically 30 minutes	Commonly used for the initial orthopedic evaluation and order for the custom abduction orthosis.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Used for postoperative follow-up visits where orthosis fit, wound checks, and adjustments are documented.
`97760`	Orthotic management and training, upper extremity, initial encounter, each 15 minutes	Billed by therapists for training the patient in donning, doffing, skin inspection, and functional use of the shoulder abduction orthosis.
`97001`	Physical therapy evaluation	Used when a physical therapist evaluates the patient’s rehabilitation needs related to shoulder immobilization and plans therapy while using the orthosis.
`99070`	Supplies and materials provided by the physician over and above those usually included with the office visit	May be used to bill for supplemental non-custom supplies or padding provided at the fitting appointment.

Related Modifiers

5 rows

Modifier	Description	When to Use
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…
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…
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…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

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…
363LP0808X	Psychiatric/Mental Health Nurse Practitioner	Physician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
207K00000X	Allergy & Immunology Physician	An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	A preventive medicine physician who specializes in preventive medicine/occupational-environmental medicine, which is focused on protecting the populat…
207QP0002X	Physician Nutrition Specialist (Family Medicine)	A physician who specializes in the diagnosis and treatment of primary nutritional diseases (e.g., undernutrition, overnutrition, and genetic or acquir…
207ZI0100X	Immunopathology Physician	A pathologist who specializes in the diagnosis of immunologic diseases.
3418M1110X	Military or U.S. Coast Guard Ground Transport Ambulance	Vehicle and staff for patient emergency or non-emergency ground transport. Includes traditional ambulances as well as ambulance buses.

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 L3967: Shoulder-Elbow-Wrist-Hand Abduction Positioning Orthosis

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HCPCS Level II L3967: Shoulder-Elbow-Wrist-Hand Abduction Positioning Orthosis

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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 L3967: Shoulder-Elbow-Wrist-Hand Abduction Positioning Orthosis

Sign up for hcpcs L3967 policy alerts

HCPCS Level II L3967: Shoulder-Elbow-Wrist-Hand Abduction Positioning Orthosis

Sign up for hcpcs L3967 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does HCPCS code L3967 represent and where is it typically provided?

In what clinical scenarios and workflow is an L3967 orthosis used?

Which CPT or other codes are commonly associated with services when L3967 is provided?

What diagnosis codes are relevant to billing L3967?

Which payers are noted in the page metadata for L3967 coverage?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does HCPCS code L3967 represent and where is it typically provided?

In what clinical scenarios and workflow is an L3967 orthosis used?

Which CPT or other codes are commonly associated with services when L3967 is provided?

What diagnosis codes are relevant to billing L3967?

Which payers are noted in the page metadata for L3967 coverage?

References