HCPCS Code L3660: Figure-of-Eight Shoulder Orthosis

## **L3660 documentation requirements** Thorough records help DME claims pass medical review by DME MACS and commercial plans. ### **Face-to-face clinical assessment** Document a face-to-face evaluation by a qualified prescriber that identifies pathology at the shoulder joint, objective findings, functional limitations, and why external support is needed for safe positioning and daily activity. ### **Standard Written Order** Maintain a complete Standard Written Order issued prior to delivery that specifies L3660 by description, notes size or model, and confirms a prefabricated, off-the-shelf device with minimal adjustments only. ### **Medical necessity and diagnosis linkage** Link ICD-10 diagnoses to the clinical need. Common examples include closed clavicle fracture, shoulder dislocation, acromioclavicular sprain, or post-operative stabilization. Explain why a figure-of-eight orthosis is preferable to a sling or a more rigid immobilizer. ### **Off-the-shelf versus custom** State that no custom fabrication or complex fitting was performed. If adjustments were limited to trimming or strap length changes, record them. This distinguishes L3660 from custom codes and supports selection of the appropriate code. ### **Proof of delivery and supplier records** Keep Proof of Delivery, product labels, and any included supplies such as extra pads or straps. Retain documentation in line with the Medicare Program Integrity Manual retention standards.

## **L3660 billing requirements** Apply payer rules so that clinical documentation translates into correct payment. ### **One unit per device** Bill one unit per orthosis supplied. L3660 spans both shoulders, so RT/LT is typically not required unless a payer explicitly demands laterality on all L-codes. ### **No add-on components** Do not unbundle pads, straps, or closures. L3660 represents the complete item. Separate component billing will be denied as incorrect coding. ### **Prior authorization and medical policy** Many plans require prior authorization for orthoses. Submit the clinical notes, the Standard Written Order, and the plan of care. Follow local DME MACS policies when Medicare is secondary. ### **Replacement and useful life** Payers may allow replacement for loss, irreparable damage, or significant wear outside a reasonable useful life. Early replacement for size change or new injury can be covered when medical necessity is documented. ### **Correct coding and product verification** Match the product to L3660 specifications. When available, use PDAC verification to show the billed HCPCS aligns with the device. This helps prevent recoding to another L-code or denial for incorrect coding.

## **L3660 applicable modifiers** Use only the modifiers your payer requires for the circumstances documented. 1. NU: New equipment purchase when the patient receives a new orthosis 2. UE: Used equipment purchase when policy allows refurbished items 3. RR: Rental when the payer treats the item as rental rather than purchase 4. GA: ABN on file when you expect a denial but obtained a signed notice 5. GZ: Expected denial and no ABN on file 6. GY: Statutorily excluded benefit category when billing for record RT/LT are generally not needed for L3660 because the figure-of-eight spans both shoulders. Apply only if the payer specifically requires laterality on all orthoses.

## **Other relevant codes** Select the appropriate code by design and fitting method. Common comparators include: - **L3650**: Figure-of-eight shoulder orthosis, prefabricated, off-the-shelf - **L3670**: Acromio-clavicular support orthosis, canvas and webbing, prefabricated - **L3671**: Custom fabricated shoulder orthosis without joints, includes fitting and adjustment - **L3675**: Vest-type shoulder abduction orthosis, prefabricated, off-the-shelf These help distinguish simple figure-eight control from more rigid or abducting designs. For non-shoulder items, do not use L3660. A wrist splint, for example, must be selected from the wrist-hand orthosis range.