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    v1.0.28
    OpenPayerBilling CodesOrthotic Procedures and servicesHCPCS hcpcs-l4396-prefabricated-adjustable-ankle-foot-orthosis
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    HCPCS L4396: Prefabricated Ankle-Foot Orthosis, Customized Fit

    HCPCS Level II code L4396 describes a prefabricated ankle-foot orthosis (AFO)—static or dynamic—provided with soft interface material and adjustable features for positioning and may be used for minimal ambulation; the item is delivered as a prefabricated device that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by a clinician or technician with orthotic expertise. Service type: orthotic device provision and customization. Typical site of service: outpatient clinic, orthotics/prosthetics facility, or durable medical equipment supplier.

    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.

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    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old patient with progressive drop foot and ankle instability following a cerebrovascular accident presents to an orthotics clinic for evaluation. The patient ambulates short distances with a walker and reports ankle weakness, frequent tripping, and difficulty positioning the foot for safe stance. A prosthetist-orthotist conducts a focused lower-extremity assessment including range of motion, muscle strength testing, gait observation, and skin integrity check. After determining that a prefabricated ankle-foot orthosis adjustable for fit will provide adequate positioning and minimal-ambulation support, the practitioner selects a L4396 device. The device is trimmed and molded at the point-of-service to the patient’s anatomy, padding is adjusted for pressure relief, and alignment is checked while the patient stands and ambulates with assistive device. The orthotist documents the medical necessity, the customization performed (trim, bend, mold, assemble), patient tolerance, measurements, and instructions for use and follow-up.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    97760Orthotic(s) management and training; initial encounter, each 15 minutesUsed for patient education, donning/doffing training, and functional training following delivery of the orthosis
    97530Therapeutic activities, direct (one-on-one) patient contactMay be billed when therapeutic activities are performed to improve functional mobility alongside orthosis fitting
    97112Neuromuscular reeducation of movement, balance, coordinationOften provided in coordination with orthosis fitting to address gait mechanics
    99070Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visitUsed to bill nonroutine supplies (padding, adhesives) provided during customization
    99024Postoperative follow-up visit globalMay apply when post-procedural adjustments or follow-up related to orthosis fall under global care (use per payer rules)

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    59Modifier 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…
    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…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    78CPT 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…
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    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    225100000XPhysical TherapistPhysical therapists (PTs) are licensed health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who…
    207R00000XInternal Medicine PhysicianA physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
    207K00000XAllergy & Immunology PhysicianAn allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    246ZC0007XSurgical AssistantA surgical assistant is a skilled practitioner who has undergone formalized education and training as a surgical assistant. The surgical assistant per…
    163WC0400XCase Management Registered NurseNursing Service Providers · Registered Nurse
    331L00000XBlood BankAn institution (organization or distinct part thereof) that performs, or is responsible for the performance of, the collection, processing, storage an…
    208C00000XColon & Rectal Surgery PhysicianA colon and rectal surgeon is trained to diagnose and treat various diseases of the intestinal tract, colon, rectum, anal canal and perianal area by m…

    Related ICD-10-CM Codes

    21 rows

    ICD-10-CM CodeDescription
    G81.90Hemiplegia, unspecified affecting unspecified side
    G81.91Hemiplegia, unspecified affecting right dominant side
    G82.20Paraplegia, unspecified
    G82.21Paraplegia, complete
    M19.071Primary osteoarthritis, right ankle and foot
    M19.072Primary osteoarthritis, left ankle and foot
    M20.11Hallux valgus (acquired), right foot
    M20.12Hallux valgus (acquired), left foot
    M24.271Disorder of ligament, right ankle
    M24.272Disorder of ligament, left ankle

    Showing 1–10 of 21

    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

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    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.
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