HCPCS code L3670: Shoulder Orthosis, Acromio-clavicular Canvas and Webbing Type, Prefabricated, Off-the-shelf

Properly use and bill HCPCS code L3670 by meeting the documentation and billing requirements enumerated in our short guide.

Use Code

## **What is HCPCS code L3670?** HCPCS code L3670, which has the following description: Shoulder orthosis (SO), acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf, refers to a prefabricated, off-the-shelf acromio-clavicular shoulder orthosis, constructed from canvas and webbing materials. Designed to support and limit motion of the acromio-clavicular (AC) joint, this orthosis is typically used for injuries and conditions like AC joint separations, clavicle injuries, and post-surgical support like physical therapy, as it provides stabilization and restricts motion to aid healing. It requires no custom fitting or molding, distinguishing it from more complex shoulder orthoses.

## **Documentation requirements** Proper documentation for L3670 should include: - A valid Standard Written Order (SWO) or Written Order Prior to Delivery (WOPD) prior to providing the orthosis. - The record must clearly state the patient's diagnosis and the medical reason for the orthosis. This should be supported by a physical evaluation and a detailed description of the injury or condition. - A detailed, written prescription for the L3670 orthosis is required. - Clinical justification describing the medical necessity, e.g., AC joint injury, stabilization requirement, or rehabilitation needs. - Confirmation that the device was off-the-shelf, not customized—i.e., no professional trimming, molding, or shaping was performed. - These records must document the item dispensed, including the date, the patient's name, and a description of the orthosis. For an off-the-shelf item like L3670, documentation should confirm that minimal self-adjustment was required. - Clear notation of laterality (right or left) per applicable modifier.

## **Billing requirements** Billing for L3670 falls under the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) category. Key billing guidelines include: - **Modifiers**: Appropriate modifiers must be used. For example, RT and LT for the right and left sides of the body, respectively. KX is a common modifier used to indicate that the documentation shows the item is medically necessary. - **Place of service**: The place of service code should correspond to where the patient will primarily use the device, most commonly the patient's home (POS 12). - **Reimbursement**: Reimbursement rates vary by payer (e.g., Medicare, Medicaid, private insurance) and geographic location. - **Pricing indicator codes**: Do note that this code has a has a pricing indicator code of 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) and a multiple pricing indicator code of A = Not applicable as HCPCS priced under one methodology. Note that there are no separate billing for fittings or adjustments—L3670 includes basic fitting.

## **Other relevant codes** - **L3660** – Figure-of-eight shoulder orthosis, canvas and webbing, prefabricated, OTS: used for surireclass management of shoulder alignment (e.g., clavicle fractures). - **L3671** – Shoulder orthosis, shoulder joint design (without joints), may include soft interface, custom fabricated with fitting and adjustment. - Ensure selection matches the orthosis type and customization level: Prefabricated, minimal fitting → L3670 or L3660 Custom-fabricated or more complex support → L3671 or other L3650–L3678 codes Separate shoulder stabilization brace codes apply for dynamic or jointed braces.

Frequently asked questions

Use L3670 when the orthosis is a simple canvas and webbing design specific to the AC joint and prefabricated without customization. Use L3660 for figure-of-eight type slings, and L3671 when the orthosis is custom fabricated.

Include a WOPD, provider justification of medical need, confirmation of OTS status, and laterality. Avoid billing prior to delivery or without proper documentation.

Yes, replacement may be covered if medically necessary—e.g., due to damage or patient condition changes—but requires documentation such as beneficiary’s ongoing need and reason for replacement, per DME MAC guidelines.