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HCPCS L3230 · Level II · orthotic and prosthetic code

L3230: Orthopedic footwear, custom shoe, depth inlay, 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 L3230

Medicare payment
paid outside OPPS
OPPS SI A: another fee schedule or payment system
Coverage code
D
special coverage instructions apply
Practitioner MUE
0
MAI 3
OPPS status
SI A
Services not paid under OPPS; paid under fee schedule or other payment system
NCCI PTP pairs
0
practitioner file
LCDs and articles
1 / 0

TL;DR

HCPCS Level II L3230 reads "Orthopedic footwear, custom shoe, depth inlay, each" in the October 2026 file; it dates from 1984. Part B does not price L3230 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 L3230. Its OPPS status indicator is A, which the I/OCE table defines as "Services not paid under OPPS; paid under fee schedule or other payment system": Medicare pays L3230 under a fee schedule or payment system other than OPPS. MUE limits for L3230: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 2, Anatomic Consideration); DME supplier 2 (MAI 2, Anatomic Consideration). 1 active LCD lists L3230: L33641 (Orthopedic Footwear). 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: L3225, L3224, L3222, L3221.

L3230 descriptor and code status

The October 2026 HCPCS Level II file describes L3230 as “Orthopedic footwear, custom shoe, depth inlay, each”. It sits in the L section (orthotic and prosthetic procedures and devices), listed with the other L codes. Although searches often call it the "L3230 CPT code", L3230 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of L3230
FieldValue
Short descriptorCustom shoes depth inlay
Added to HCPCS1984-01-01
Last actionN (no maintenance), effective 2006-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator00: not separately priced by Part B
BETOS categoryD1F: prosthetic/orthotic devices
Type of serviceP: lump-sum purchase of DME, prosthetics or orthotics

Medicare payment for L3230

Part B does not price L3230 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 L3230. Its OPPS status indicator is A, which the I/OCE table defines as "Services not paid under OPPS; paid under fee schedule or other payment system": Medicare pays L3230 under a fee schedule or payment system other than OPPS. 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 A (Services not paid under OPPS; paid under fee schedule or other payment system), with no separate OPPS payment rate.

Medically Unlikely Edits for L3230

MUE limits for L3230: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 2, Anatomic Consideration); DME supplier 2 (MAI 2, Anatomic Consideration). 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 L3230 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital22 Date of Service Edit: PolicyAnatomic Consideration
DME supplier22 Date of Service Edit: PolicyAnatomic Consideration

The MUE lookup for L3230 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists L3230 in v323r0.

L3230 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 L3230 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for L3230

1 active Local Coverage Determination and 0 billing and coding articles list L3230. 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 L3230

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists L3230

CARC 151 · N362

units of L3230 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 L3230 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for L3230 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 L3230

What does HCPCS code L3230 describe?

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

Is L3230 a CPT code?

No: CMS maintains L3230 in HCPCS Level II, while the AMA maintains CPT. People do search "L3230 CPT code", and it goes in the same procedure-code field.

What does Medicare pay for L3230?

Part B does not price L3230 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 L3230. Its OPPS status indicator is A, which the I/OCE table defines as "Services not paid under OPPS; paid under fee schedule or other payment system": Medicare pays L3230 under a fee schedule or payment system other than OPPS.

How many units of L3230 can be billed per day?

MUE limits for L3230: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 2, Anatomic Consideration); DME supplier 2 (MAI 2, Anatomic Consideration). 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 L3230?

Coverage code D (special coverage instructions apply). 1 active LCD lists L3230: 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.