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    v1.0.28
    OpenPayerBilling CodesOrthotic Procedures and servicesHCPCS hcpcs-l4397-prefabricated-ankle-foot-orthosis-adjustable-positioning
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    HCPCS L4397: Prefabricated Adjustable Ankle Foot Orthosis

    HCPCS Level II code L4397 describes a prefabricated, off-the-shelf static or dynamic ankle foot orthosis (AFO) with soft interface material that is adjustable for fit and intended for positioning and may be used for minimal ambulation; service type is durable medical equipment for lower-extremity bracing, and the typical site of service is outpatient clinics, durable medical equipment suppliers, or home use where the device is fitted and dispensed.

    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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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old patient with diabetic peripheral neuropathy and a drop foot deformity presents to an outpatient orthotics clinic after referral from their primary care provider. The patient reports instability during short household ambulation and difficulty with foot positioning leading to frequent tripping. A certified orthotist performs a focused lower-extremity assessment, documents weight-bearing and gait, measures the affected limb, and determines that a prefabricated, off-the-shelf ankle foot orthosis is appropriate for positioning and minimal ambulation. The orthotist fits L4397 (static or dynamic ankle foot orthosis, prefabricated, off-the-shelf), adjusts soft interface materials for comfort, documents functional limitations, instructs the patient on use and skin checks, and provides written durable medical equipment documentation for billing. Typical workflow includes: referral and evaluation, measurement and fitting during the same visit or a short follow-up, patient education, and submission of the DME claim to the payer with appropriate modifier(s) and diagnosis code(s). Typical site of service is an outpatient orthotics/prosthetics clinic, DME supplier office, or hospital outpatient clinic for minimal ambulatory support needs.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99213Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutesUsed by the referring clinician or orthotist for the evaluation and documentation supporting the AFO order
    97760Orthotic management and training, upper extremity, lower extremity, and/or trunk, initial encounter (including assessment and fitting)Used by therapists to document training and functional use of the AFO during fitting and follow-up sessions
    97763Orthotic management and training, lower extremity, initial encounterUsed when specific orthotic training for a lower-extremity orthosis is provided by therapy services
    99070Supplies and materials provided by the physician over and above those usually included with the office visitUsed to bill for additional supplies (padding, straps) provided that are not included in the off-the-shelf AFO billing
    A9270Non-covered item or service — DME supply code (used for informational reporting)Occasionally used by payers/suppliers for reporting non-covered DME components in coordination with L4397

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    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…
    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…
    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…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…

    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…
    208D00000XGeneral Practice PhysicianA physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
    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…
    208000000XPediatrics PhysicianA pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
    332S00000XHearing Aid EquipmentThe manufacture and/or sale of electronic hearing aids, their component parts, and related products and services on a national basis.
    133VN1006XMetabolic Nutrition Registered DietitianA registered dietitian who achieves specialized competency in metabolic nutrition.
    261QC0050XCritical Access Hospital Clinic/CenterAn outpatient entity, facility, or distinct part of a facility within or affiliated with a Critical Access Hospital that provides access to primary ca…
    2086S0122XPlastic and Reconstructive Surgery PhysicianA surgeon who specializes in plastic and reconstructive surgery.

    Related ICD-10-CM Codes

    25 rows

    ICD-10-CM CodeDescription
    E11.52Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene
    E11.621Type 2 diabetes mellitus with foot ulcer
    G82.20Paraplegia, unspecified
    G82.21Paraplegia, complete
    G83.4Cauda equina syndrome
    M10.271Drug-induced gout, right ankle and foot
    M16.11Unilateral primary osteoarthritis, right hip
    M21.371Foot drop, right foot
    M21.372Foot drop, left foot
    M24.171Other articular cartilage disorders, right ankle

    Showing 1–10 of 25

    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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