L3540 HCPCS code: Orthopedic shoe addition, sole, full
L3540 is the HCPCS Level II code for orthopedic shoe addition, sole, full. The 2026 Medicare DMEPOS fee schedule pays $61.04 to $67.13 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 51% from 2022 to 2024 (102 to 50 services). In 2024, 32 suppliers billed Medicare for L3540 (purchases), serving 36 beneficiaries. Its average fee ranks 8 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 L3540
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $61.04 | $67.13 | $74.48 | $55.86 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $61.04 | — |
| AL | — | $62.87 | — |
| AR | — | $62.84 | — |
| AZ | — | $61.04 | — |
| CA | — | $61.04 | — |
| CO | — | $63.21 | — |
| CT | — | $61.04 | — |
| DC | — | $61.04 | — |
| DE | — | $61.04 | — |
| FL | — | $62.87 | — |
| GA | — | $62.87 | — |
| HI | — | $61.04 | — |
| IA | — | $62.21 | — |
| ID | — | $61.04 | — |
| IL | — | $62.52 | — |
| IN | — | $62.52 | — |
| KS | — | $62.21 | — |
| KY | — | $62.87 | — |
| LA | — | $62.84 | — |
| MA | — | $61.04 | — |
| MD | — | $61.04 | — |
| ME | — | $61.04 | — |
| MI | — | $62.52 | — |
| MN | — | $62.52 | — |
| MO | — | $62.21 | — |
| MS | — | $62.87 | — |
| MT | — | $63.21 | — |
| NC | — | $62.87 | — |
| ND | — | $63.21 | — |
| NE | — | $62.21 | — |
| NH | — | $61.04 | — |
| NJ | — | $61.04 | — |
| NM | — | $62.84 | — |
| NV | — | $61.04 | — |
| NY | — | $61.04 | — |
| OH | — | $62.52 | — |
| OK | — | $62.84 | — |
| OR | — | $61.04 | — |
| PA | — | $61.04 | — |
| PR | — | $67.13 | — |
| RI | — | $61.04 | — |
| SC | — | $62.87 | — |
| SD | — | $63.21 | — |
| TN | — | $62.87 | — |
| TX | — | $62.84 | — |
| UT | — | $63.21 | — |
| VA | — | $61.04 | — |
| VI | — | $67.13 | — |
| VT | — | $61.04 | — |
| WA | — | $61.04 | — |
| WI | — | $62.52 | — |
| WV | — | $61.04 | — |
| WY | — | $63.21 | — |
How the L3540 fee compares
| Measure | Value |
|---|---|
| Rank among 11 L35 codes (lowest = 1) | 8 |
| Family fee range (average of state fees) | $10.89–$104.23 |
| Rural fee uplift | — |
Who bills L3540 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 32 |
| Referring clinicians | 36 |
| Medicare beneficiaries | 36 |
| States with claims | 0 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 54 | 84 |
| 2023 | 36 | 59 |
| 2024 | 32 | 36 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L3540, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 102 | 84 | $52.71 | $40.00 |
| 2023 | 70 | 59 | $55.32 | $43.37 |
| 2024 | 50 | 36 | $56.85 | $44.58 |
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 L3540
- 2026-01-01: Average state fee rose 2.0%: $61.00 to $62.22
- 1986-01-01: L3540 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 L3540?
L3540 is the HCPCS Level II code for orthopedic shoe addition, sole, full. Short descriptor: "Ortho shoe add full sole".
How much does Medicare pay for L3540?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $61.04–$67.13. Rural fees can be higher.
Does Medicare cover L3540?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for L3540?
Medicare policy articles that cite L3540 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.
Did the Medicare fee for L3540 change in 2026?
The average non-rural state fee moved from $61.00 in 2025 to $62.22 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L3540 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)
- L3530 — Orthopedic shoe addition, sole, half ($38.11–$41.95)
- 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)
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 L3540
- Watch L3540 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L3540
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.