## **What is the HCPCS code L3906 for?**
The HCPCS code L3906 is meant to designate a wrist hand orthosis that has no joints, but it may include soft interface material for its interface and some straps. It's also a custom-fabricated orthosis, and the service includes fitting and adjustment for the specific patient availing of this orthosis.
The purpose of this orthosis is to immobilize the wrist and the entire hand in a specific position to help it heal over time and reduce wrist and hand pain. If not to immobilize, it is there to provide support to aid in improving wrist function.
This orthosis is mostly issued to patients who have any of the following problems or states:
- Wrist sprains or fractures
- Tendonitis of the wrist
- Soft tissue injuries of the wrist
- Arthritis
- Neurological problems that affect the hand and wrist
- Post-surgery recovery for the wrist
The healthcare provider handling the patient will conduct an assessment to determine the specifications of the orthosis, and they will make custom molds and measurements to ensure that it's the perfect fit for the patient.
## **Documentation requirements for L3906**
Before filing for a claim for L3906, please make sure you have sufficient documentation:
- The full name of the patient receiving the orthosis
- The full name and credentials of the healthcare providers involved in assessing the patient, and the fitting and customization of the orthosis
- The patient's medical history and any relevant clinical indications and diagnoses to justify the medical necessity of the orthosis
- Documentation that supports the substantial modification of the orthosis for the patient, and that customization was done by a certified orthotist or similarly trained professional at the time of delivery
- Standard written order (SWO) or written order prior to delivery (WOPD) and proof of delivery
- Wrist imaging test results (X-rays, MRIs, etc.)
Please make sure that documentation aligns with the specifications mandated by any applicable Local Coverage Determination (LCD) for upper limb orthoses or the Medicare Program Integrity Manual.
## **Billing requirements for L3906**
Besides the documentation requirements above, please make sure to prepare and take note of the following:
- You have the relevant diagnosis codes based on the patient's condition
- The use of either the RT or LT modifiers. RT for the right wrist, LT for the left. If both wrists require orthoses, submit two lines with RT and LT separately, each with one unit
- This is a custom-fabricated orthosis, so no add-on orthotic codes should be billed alongside it
Please follow CMS/relevant coding guidelines to avoid claim rejections.
## **Other similar codes**
- **L3766** - Elbow wrist hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
- **L3806** - Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment
- **L3808** - Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment
- **L3900** - Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/flexion, finger flexion/extension, wrist or finger driven, custom-fabricated
- **L3901** - Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/flexion, finger flexion/extension, cable driven, custom-fabricated
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