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HCPCS L4210 · Level II · orthotic and prosthetic code

L4210: Repair of orthotic device, repair or replace minor parts, 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 L4210

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
2 / 0

TL;DR

L4210 is a Level II code from the L section (orthotic and prosthetic procedures and devices), in use since 1985: "Repair of orthotic device, repair or replace minor parts". None of the October 2026 PFS, DMEPOS, CLFS, OPPS or ASC files lists a national amount for L4210; its HCPCS pricing indicator is 46 (DMEPOS contractor-priced (not otherwise classified, individual determination or gap-filled)). 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 L4210 under a fee schedule or payment system other than OPPS. Its 2026 Q4 MUEs per date of service: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 4 (MAI 3, Clinical: Data); DME supplier 4 (MAI 3, Clinical: Data). 2 active LCDs list L4210: L33318 (Knee Orthoses), L33686 (Ankle-Foot/Knee-Ankle-Foot Orthosis). HCPCS record: BETOS D1F (prosthetic/orthotic devices); pricing indicator 46; type of service P (lump-sum purchase of DME, prosthetics or orthotics). 1 other active code opens with "Repair of orthotic device"; related codes: L4205, L4350, L4060, L4360.

L4210 descriptor and code status

The October 2026 HCPCS Level II file describes L4210 as “Repair of orthotic device, repair or replace minor parts”. It sits in the L section (orthotic and prosthetic procedures and devices), listed with the other L codes. Although searches often call it the "L4210 CPT code", L4210 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 L4210
FieldValue
Short descriptorOrth dev repair/repl minor p
Added to HCPCS1985-01-01
Last actionN (no maintenance), effective 1996-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator46: DMEPOS contractor-priced (not otherwise classified, individual determination or gap-filled)
BETOS categoryD1F: prosthetic/orthotic devices
Type of serviceP: lump-sum purchase of DME, prosthetics or orthotics

Medicare payment for L4210

None of the October 2026 PFS, DMEPOS, CLFS, OPPS or ASC files lists a national amount for L4210; its HCPCS pricing indicator is 46 (DMEPOS contractor-priced (not otherwise classified, individual determination or gap-filled)). 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 L4210 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 L4210

Its 2026 Q4 MUEs per date of service: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 4 (MAI 3, Clinical: Data); DME supplier 4 (MAI 3, Clinical: Data). 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 L4210 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital43 Date of Service Edit: ClinicalClinical: Data
DME supplier43 Date of Service Edit: ClinicalClinical: Data

The MUE lookup for L4210 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists L4210 in v323r0.

L4210 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 L4210 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for L4210

2 active Local Coverage Determinations and 0 billing and coding articles list L4210. 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 L4210

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists L4210

CARC 151 · N362

units of L4210 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 the description, invoice or pricing detail a contractor-priced code needs

Where QuickIntell fits for L4210 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for L4210 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 L4210

What does HCPCS code L4210 describe?

"Repair of orthotic device, repair or replace minor parts" (short descriptor "Orth dev repair/repl minor p"), in the L section (orthotic and prosthetic procedures and devices). Added 1985-01-01; last action N (no maintenance) effective 1996-01-01.

Is L4210 a CPT code?

No. L4210 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set. Searches for "L4210 CPT code" mean this Level II code.

What does Medicare pay for L4210?

None of the October 2026 PFS, DMEPOS, CLFS, OPPS or ASC files lists a national amount for L4210; its HCPCS pricing indicator is 46 (DMEPOS contractor-priced (not otherwise classified, individual determination or gap-filled)). 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 L4210 under a fee schedule or payment system other than OPPS.

How many units of L4210 can be billed per day?

Its 2026 Q4 MUEs per date of service: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 4 (MAI 3, Clinical: Data); DME supplier 4 (MAI 3, Clinical: Data). 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 L4210?

Coverage code D (special coverage instructions apply). 2 active LCDs list L4210: L33318 (Knee Orthoses), L33686 (Ankle-Foot/Knee-Ankle-Foot Orthosis).

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.