L3530 HCPCS code: Orthopedic shoe addition, sole, half
L3530 is the HCPCS Level II code for orthopedic shoe addition, sole, half. The 2026 Medicare DMEPOS fee schedule pays $38.11 to $41.95 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. Its average fee ranks 6 of 11 L35 codes (family range $10.89–$104.23).
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 | 1986-01-01 |
| Last action effective | 1999-01-01 |
2026 Medicare DMEPOS fee schedule for L3530
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $38.11 | $41.95 | $46.52 | $34.89 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $38.11 | — |
| AL | — | $39.28 | — |
| AR | — | $39.27 | — |
| AZ | — | $38.11 | — |
| CA | — | $38.11 | — |
| CO | — | $39.50 | — |
| CT | — | $38.11 | — |
| DC | — | $38.11 | — |
| DE | — | $38.11 | — |
| FL | — | $39.28 | — |
| GA | — | $39.28 | — |
| HI | — | $38.11 | — |
| IA | — | $38.87 | — |
| ID | — | $38.11 | — |
| IL | — | $39.08 | — |
| IN | — | $39.08 | — |
| KS | — | $38.87 | — |
| KY | — | $39.28 | — |
| LA | — | $39.27 | — |
| MA | — | $38.11 | — |
| MD | — | $38.11 | — |
| ME | — | $38.11 | — |
| MI | — | $39.08 | — |
| MN | — | $39.08 | — |
| MO | — | $38.87 | — |
| MS | — | $39.28 | — |
| MT | — | $39.50 | — |
| NC | — | $39.28 | — |
| ND | — | $39.50 | — |
| NE | — | $38.87 | — |
| NH | — | $38.11 | — |
| NJ | — | $38.11 | — |
| NM | — | $39.27 | — |
| NV | — | $38.11 | — |
| NY | — | $38.11 | — |
| OH | — | $39.08 | — |
| OK | — | $39.27 | — |
| OR | — | $38.11 | — |
| PA | — | $38.11 | — |
| PR | — | $41.95 | — |
| RI | — | $38.11 | — |
| SC | — | $39.28 | — |
| SD | — | $39.50 | — |
| TN | — | $39.28 | — |
| TX | — | $39.27 | — |
| UT | — | $39.50 | — |
| VA | — | $38.11 | — |
| VI | — | $41.95 | — |
| VT | — | $38.11 | — |
| WA | — | $38.11 | — |
| WI | — | $39.08 | — |
| WV | — | $38.11 | — |
| WY | — | $39.50 | — |
How the L3530 fee compares
| Measure | Value |
|---|---|
| Rank among 11 L35 codes (lowest = 1) | 6 |
| Family fee range (average of state fees) | $10.89–$104.23 |
| Rural fee uplift | — |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 2 | Anatomic Consideration |
| outpatient hospital claims | 2 | Anatomic Consideration |
What changed for L3530
- 2026-01-01: Average state fee rose 2.0%: $38.10 to $38.87
- 1986-01-01: L3530 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 L3530?
L3530 is the HCPCS Level II code for orthopedic shoe addition, sole, half. Short descriptor: "Ortho shoe add half sole".
How much does Medicare pay for L3530?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $38.11–$41.95. Rural fees can be higher.
Does Medicare cover L3530?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for L3530 change in 2026?
The average non-rural state fee moved from $38.10 in 2025 to $38.87 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L3530 can be billed per day?
2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).
Related L35 codes
- L3500 — Orthopedic shoe addition, insole, leather ($35.09–$38.58)
- L3510 — Orthopedic shoe addition, insole, rubber ($35.09–$38.58)
- L3520 — Orthopedic shoe addition, insole, felt covered with leather ($38.11–$41.95)
- L3540 — Orthopedic shoe addition, sole, full ($61.04–$67.13)
- L3550 — Orthopedic shoe addition, toe tap standard ($10.65–$11.76)
- L3560 — Orthopedic shoe addition, toe tap, horseshoe ($27.48–$30.16)
- L3570 — Orthopedic shoe addition, special extension to instep (leather with eyelets) ($102.26–$112.44)
- L3580 — Orthopedic shoe addition, convert instep to velcro closure ($77.81–$85.58)
- L3590 — Orthopedic shoe addition, convert firm shoe counter to soft counter ($64.07–$70.44)
- L3595 — Orthopedic shoe addition, march bar ($50.33–$55.39)
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Next steps
- Run a reimbursement report for a device billed under L3530
- Watch L3530 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L3530
Sources: CMS HCPCS Level II release October 2025; 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.