L3265 HCPCS code: Plastazote sandal, each
L3265 is the HCPCS Level II code for plastazote sandal, each. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 1 per day on outpatient hospital claims.
Code details
| Field | Value |
|---|---|
| Section | L codes — Orthotic and prosthetic procedures and devices |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 00 — Not separately priced by Medicare |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 1984-01-01 |
| Last action effective | 1996-01-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Clinical: Data |
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
Covered diagnoses (84 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| Q72.00 | Congenital complete absence of unspecified lower limb | 1 |
| Q72.01 | Congenital complete absence of right lower limb | 1 |
| Q72.02 | Congenital complete absence of left lower limb | 1 |
| Q72.03 | Congenital complete absence of lower limb, bilateral | 1 |
| Q72.30 | Congenital absence of unspecified foot and toe(s) | 1 |
| Q72.31 | Congenital absence of right foot and toe(s) | 1 |
| Q72.32 | Congenital absence of left foot and toe(s) | 1 |
| Q72.33 | Congenital absence of foot and toe(s), bilateral | 1 |
| Q72.70 | Split foot, unspecified lower limb | 1 |
| Q72.71 | Split foot, right lower limb | 1 |
Showing 10 of 84. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for L3265
- 1984-01-01: L3265 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 L3265?
L3265 is the HCPCS Level II code for plastazote sandal, each. Short descriptor: "Plastazote sandal each".
Does Medicare cover L3265?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for L3265?
Medicare policy articles that cite L3265 list 84 covered ICD-10-CM diagnosis codes across 1 article. The most cited include Q72.00 (Congenital complete absence of unspecified lower limb), Q72.01 (Congenital complete absence of right lower limb), Q72.02 (Congenital complete absence of left lower limb). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of L3265 can be billed per day?
1 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 L3265
- Watch L3265 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L3265
Sources: CMS HCPCS Level II release October 2025; 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.