L3485 HCPCS code: Heel, pad, removable for spur
L3485 is the HCPCS Level II code for heel, pad, removable for spur. In 2023 Medicare paid an average of $22.88 per service for L3485 across 14 services. 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 81% from 2022 to 2023 (75 to 14 services). In 2023, 3 suppliers billed Medicare for L3485 (purchases), serving 12 beneficiaries.
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 |
Who bills L3485 (2023)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 3 |
| Referring clinicians | 6 |
| Medicare beneficiaries | 12 |
| States with claims | 0 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 23 | 65 |
| 2023 | 3 | 12 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L3485, 2022–2023
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 75 | 65 | $27.71 | $19.09 |
| 2023 | 14 | 12 | $31.41 | $22.88 |
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
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 L3485
- 1984-01-01: L3485 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 L3485?
L3485 is the HCPCS Level II code for heel, pad, removable for spur. Short descriptor: "Shoe heel pad removable for".
How much does Medicare pay for L3485?
In 2023, the average Medicare payment was $22.88 per service (average allowed $31.41).
Does Medicare cover L3485?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for L3485?
Medicare policy articles that cite L3485 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 L3485 can be billed per day?
2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).
Related L34 codes
- L3400 — Metatarsal bar wedge, rocker ($48.83–$53.69)
- L3410 — Metatarsal bar wedge, between sole ($111.35–$122.47)
- L3420 — Full sole and heel wedge, between sole ($65.62–$72.12)
- L3430 — Heel, counter, plastic reinforced ($192.22–$211.48)
- L3440 — Heel, counter, leather reinforced ($91.55–$100.71)
- L3450 — Heel, sach cushion type ($126.64–$139.27)
- L3455 — Heel, new leather, standard ($48.83–$53.69)
- L3460 — Heel, new rubber, standard ($41.16–$45.31)
- L3465 — Heel, thomas with wedge ($70.16–$77.19)
- L3470 — Heel, thomas extended to ball ($74.74–$82.20)
- L3480 — Heel, pad and depression for spur ($74.74–$82.20)
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 L3485
- Watch L3485 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L3485
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.