L3225 HCPCS code: Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis)
L3225 is the HCPCS Level II code for orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis). The 2026 Medicare DMEPOS fee schedule pays $77.73 to $140.82 depending on the state. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 2 per day on DME suppliers. Medicare volume fell 10% from 2022 to 2024 (683 to 617 services). In 2024, 286 suppliers billed Medicare for L3225 (purchases), serving 481 beneficiaries; Pennsylvania, Missouri, Kentucky accounted for 29% of services.
Code details
| Field | Value |
|---|---|
| Section | L codes — Orthotic and prosthetic procedures and devices |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 38 — DMEPOS: orthotics, prosthetics, prosthetic devices and vision services |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 1995-01-01 |
| Last action effective | 1995-01-01 |
2026 Medicare DMEPOS fee schedule for L3225
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $77.73 | $140.82 | $103.64 | $77.73 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $131.64 | — |
| AL | — | $77.73 | — |
| AR | — | $79.22 | — |
| AZ | — | $103.64 | — |
| CA | — | $103.64 | — |
| CO | — | $93.77 | — |
| CT | — | $103.64 | — |
| DC | — | $78.49 | — |
| DE | — | $78.49 | — |
| FL | — | $77.73 | — |
| GA | — | $77.73 | — |
| HI | — | $140.82 | — |
| IA | — | $96.09 | — |
| ID | — | $77.73 | — |
| IL | — | $90.70 | — |
| IN | — | $90.70 | — |
| KS | — | $96.09 | — |
| KY | — | $77.73 | — |
| LA | — | $79.22 | — |
| MA | — | $103.64 | — |
| MD | — | $78.49 | — |
| ME | — | $103.64 | — |
| MI | — | $90.70 | — |
| MN | — | $90.70 | — |
| MO | — | $96.09 | — |
| MS | — | $77.73 | — |
| MT | — | $93.77 | — |
| NC | — | $77.73 | — |
| ND | — | $93.77 | — |
| NE | — | $96.09 | — |
| NH | — | $103.64 | — |
| NJ | — | $83.59 | — |
| NM | — | $79.22 | — |
| NV | — | $103.64 | — |
| NY | — | $83.59 | — |
| OH | — | $90.70 | — |
| OK | — | $79.22 | — |
| OR | — | $77.73 | — |
| PA | — | $78.49 | — |
| PR | — | $138.06 | — |
| RI | — | $103.64 | — |
| SC | — | $77.73 | — |
| SD | — | $93.77 | — |
| TN | — | $77.73 | — |
| TX | — | $79.22 | — |
| UT | — | $93.77 | — |
| VA | — | $78.49 | — |
| VI | — | $83.56 | — |
| VT | — | $103.64 | — |
| WA | — | $77.73 | — |
| WI | — | $90.70 | — |
| WV | — | $78.49 | — |
| WY | — | $93.77 | — |
How the L3225 fee compares
| Measure | Value |
|---|---|
| Rank among 2 L32 codes (lowest = 1) | 2 |
| Family fee range (average of state fees) | $78.99–$90.70 |
| Rural fee uplift | — |
Who bills L3225 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 286 |
| Referring clinicians | 469 |
| Medicare beneficiaries | 481 |
| States with claims | 18 |
| Share of services in top 3 states (Pennsylvania, Missouri, Kentucky) | 29% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 323 | 523 |
| 2023 | 272 | 465 |
| 2024 | 286 | 481 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L3225, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 683 | 523 | $72.58 | $54.94 |
| 2023 | 584 | 465 | $79.37 | $60.83 |
| 2024 | 617 | 481 | $81.29 | $62.68 |
States with the most L3225 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Pennsylvania | 58 | $59.32 |
| Missouri | 46 | $71.68 |
| Kentucky | 45 | $59.21 |
| Tennessee | 36 | $58.41 |
| Virginia | 35 | $58.92 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 2 | Anatomic Consideration |
| outpatient hospital claims | 2 | Anatomic Consideration |
Medicare policy articles for this code
- A52481: Orthopedic Footwear - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
- A52501: Therapeutic Shoes for Persons with Diabetes - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (512 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| E08.00 | Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) | 1 |
| E08.01 | Diabetes mellitus due to underlying condition with hyperosmolarity with coma | 1 |
| E08.10 | Diabetes mellitus due to underlying condition with ketoacidosis without coma | 1 |
| E08.11 | Diabetes mellitus due to underlying condition with ketoacidosis with coma | 1 |
| E08.21 | Diabetes mellitus due to underlying condition with diabetic nephropathy | 1 |
| E08.22 | Diabetes mellitus due to underlying condition with diabetic chronic kidney disease | 1 |
| E08.29 | Diabetes mellitus due to underlying condition with other diabetic kidney complication | 1 |
| E08.311 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema | 1 |
| E08.319 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema | 1 |
| E08.3211 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye | 1 |
Showing 10 of 512. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for L3225
- 2026-01-01: Average state fee rose 2.0%: $88.93 to $90.70
- 1995-01-01: L3225 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code L3225?
L3225 is the HCPCS Level II code for orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis). Short descriptor: "Man's shoe oxford brace".
How much does Medicare pay for L3225?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $77.73–$140.82. Rural fees can be higher.
Does Medicare cover L3225?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for L3225?
Medicare policy articles that cite L3225 list 512 covered ICD-10-CM diagnosis codes across 2 articles. The most cited include E08.00 (Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)), E08.01 (Diabetes mellitus due to underlying condition with hyperosmolarity with coma), E08.10 (Diabetes mellitus due to underlying condition with ketoacidosis without coma). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
Did the Medicare fee for L3225 change in 2026?
The average non-rural state fee moved from $88.93 in 2025 to $90.70 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L3225 can be billed per day?
2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).
Related L32 codes
- L3201 — Orthopedic shoe, oxford with supinator or pronator, infant
- L3202 — Orthopedic shoe, oxford with supinator or pronator, child
- L3203 — Orthopedic shoe, oxford with supinator or pronator, junior
- L3204 — Orthopedic shoe, hightop with supinator or pronator, infant
- L3206 — Orthopedic shoe, hightop with supinator or pronator, child
- L3207 — Orthopedic shoe, hightop with supinator or pronator, junior
- L3208 — Surgical boot, each, infant
- L3209 — Surgical boot, each, child
- L3211 — Surgical boot, each, junior
- L3212 — Benesch boot, pair, infant
- L3213 — Benesch boot, pair, child
- L3214 — Benesch boot, pair, junior
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under L3225
- Watch L3225 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L3225
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.