HCPCS L3933: Finger Orthosis (FO), without joints, custom

## **HCPCS code L3933 documentation requirements** Accurate and detailed documentation is essential for billing this code. Your patient's medical records must clearly demonstrate the medical necessity for a custom-fabricated orthosis, including: - A written prescription from a licensed practitioner, such as a physician, specifying the exact item. - The patient's diagnosis, prognosis, and a description of their functional limitations. - A clear explanation of why a less-expensive, prefabricated, or off-the-shelf orthosis would not meet the patient's needs. This is a critical point for justifying the higher cost of a custom device. - Documentation of the fabrication process, including the use of raw materials and the substantial work involved (e.g., molding, cutting, bending). - A detailed description of the fitting and adjustments made to the orthosis at the time of delivery to ensure a personalized fit. - Proof of delivery and patient authorization.

## **L3933 billing requirements** To prevent denial of claims, the following billing requirements must be kept in mind: - **Custom fabrication**: The code is for a device that is individually made from basic materials (like plastic, metal, or cloth) for a specific patient. It can't be used for a prefabricated item that is merely trimmed or adjusted. - **Modifiers**: You must use laterality modifiers (LT or RT) to indicate whether the orthosis is for the left or right hand. If you are billing for a custom finger orthosis for both hands on the same date of service, you must bill each item on a separate claim line with the appropriate LT or RT modifier and a single unit of service for each. - **Included services**: The code includes the cost of the orthosis itself, as well as the initial assessment, fabrication time, materials, and teaching the patient how to use and care for the device. Minor adjustments on subsequent visits are also considered part of the service and are not typically billed separately. - **Prior authorization**: Many payers, including Medicare and Medicaid, require prior authorization for orthotic devices like L3933. It is crucial to obtain this authorization before providing the device to ensure reimbursement. - **DMEPOS**: This code falls under the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) category, which has specific billing rules and requirements, including the need for a separate DMEPOS number to bill Medicare.

## **Other relevant codes** - **L3765**: Elbow wrist hand finger orthosis (EWHFO), rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment - **L3935**: Finger orthosis (FO), nontorsion joint, may include soft interface, custom fabricated, includes fitting and adjustment - **L3919**: Hand orthosis (HO), without joints, may include soft interface, straps, custom fabricated, including fitting and adjustment - **L3923**: Hand finger orthosis (HFO), without joints, may include soft interface, straps, a prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise - **L3924**: Hand finger orthosis without joints, may include soft interface, straps, prefabricated, off-the-shelf - **L3927**: Finger orthosis (FO), proximal interphalangeal (PIP)/distal interphalangeal (DIP), without joint/spring, extension/flexion (e.g., static or ring type), may include soft interface material, prefabricated, off-the-shelf.