L3251 HCPCS code: Foot, shoe molded to patient model, silicone shoe, each
L3251 is the HCPCS Level II code for foot, shoe molded to patient model, silicone shoe, each. 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.
Code details
| Field | Value |
|---|---|
| Section | L codes — Orthotic and prosthetic procedures and devices |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 00 — Not separately priced by Medicare |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 1984-01-01 |
| Last action effective | 1997-01-01 |
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 L3251
- 1984-01-01: L3251 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 L3251?
L3251 is the HCPCS Level II code for foot, shoe molded to patient model, silicone shoe, each. Short descriptor: "Shoe molded to pt silicone s".
Does Medicare cover L3251?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for L3251?
Medicare policy articles that cite L3251 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.
How many units of L3251 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 L3251
- Watch L3251 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L3251
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule; 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.