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HCPCS L3219 · Level II · orthotic and prosthetic code

L3219: Orthopedic footwear, mens shoe, oxford, each, HCPCS Level II orthotic and prosthetic code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for L3219

Medicare payment
not separately priced
HCPCS pricing indicator 00 (Part B)
Coverage code
S
non-covered by Medicare statute
Practitioner MUE
0
MAI 3
OPPS status
SI E1
Non-allowed item or service
NCCI PTP pairs
0
practitioner file
LCDs and articles
1 / 0

TL;DR

L3219 is a Level II code from the L section (orthotic and prosthetic procedures and devices), in use since 1984: "Orthopedic footwear, mens shoe, oxford, each". Part B does not price L3219 separately: the HCPCS file gives it pricing indicator 00. None of the October 2026 PFS, DMEPOS, CLFS, OPPS or ASC files lists a national amount for L3219. CMS caps L3219 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 0 (MAI 3, Published Contractor Policy) units per day in the 2026 Q4 MUE tables. 1 active LCD lists L3219: L33641 (Orthopedic Footwear). OPPS status indicator E1: Non-allowed item or service. HCPCS record: BETOS D1F (prosthetic/orthotic devices); pricing indicator 00; type of service P (lump-sum purchase of DME, prosthetics or orthotics). 10 other active codes open with "Orthopedic footwear"; related codes: L3224, L3225, L3230, L3217.

L3219 descriptor and code status

The October 2026 HCPCS Level II file describes L3219 as “Orthopedic footwear, mens shoe, oxford, each”. It sits in the L section (orthotic and prosthetic procedures and devices), listed with the other L codes.

HCPCS file attributes of L3219
FieldValue
Short descriptorOrthopedic mens shoes oxford
Added to HCPCS1984-01-01
Last actionN (no maintenance), effective 2006-01-01
Coverage codeS: non-covered by Medicare statute
Pricing indicator00: not separately priced by Part B
BETOS categoryD1F: prosthetic/orthotic devices
Type of serviceP: lump-sum purchase of DME, prosthetics or orthotics
Statute1862A8

Medicare payment for L3219

Part B does not price L3219 separately: the HCPCS file gives it pricing indicator 00. None of the October 2026 PFS, DMEPOS, CLFS, OPPS or ASC files lists a national amount for L3219. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Hospital outpatient (OPPS Addendum B)

Status indicator E1 (Non-allowed item or service), with no separate OPPS payment rate.

Medically Unlikely Edits for L3219

CMS caps L3219 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 0 (MAI 3, Published Contractor Policy) units per day in the 2026 Q4 MUE tables. The practitioner MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for L3219 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital03 Date of Service Edit: ClinicalCMS Policy
DME supplier03 Date of Service Edit: ClinicalPublished Contractor Policy

The MUE lookup for L3219 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists L3219 in v323r0.

L3219 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check L3219 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for L3219

1 active Local Coverage Determination and 0 billing and coding articles list L3219. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Denials to expect on L3219

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists L3219

CARC 151 · N362

units of L3219 exceed the practitioner MUE of 0 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for L3219 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for L3219 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS L3219

What does HCPCS code L3219 describe?

"Orthopedic footwear, mens shoe, oxford, each" (short descriptor "Orthopedic mens shoes oxford"), in the L section (orthotic and prosthetic procedures and devices). Added 1984-01-01; last action N (no maintenance) effective 2006-01-01.

Is L3219 a CPT code?

It is not. L3219 belongs to the L section (orthotic and prosthetic procedures and devices) of HCPCS Level II, the CMS code set, not to AMA CPT.

What does Medicare pay for L3219?

Part B does not price L3219 separately: the HCPCS file gives it pricing indicator 00. None of the October 2026 PFS, DMEPOS, CLFS, OPPS or ASC files lists a national amount for L3219.

How many units of L3219 can be billed per day?

CMS caps L3219 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 0 (MAI 3, Published Contractor Policy) units per day in the 2026 Q4 MUE tables. For the practitioner MUE (MAI 3), units above 0 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover L3219?

Coverage code S (non-covered by Medicare statute). 1 active LCD lists L3219: L33641 (Orthopedic Footwear).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.