L3649 HCPCS code: Orthopedic shoe, modification, addition or transfer, not otherwise specified
L3649 is the HCPCS Level II code for orthopedic shoe, modification, addition or transfer, not otherwise specified. In 2024 Medicare paid an average of $181.65 per service for L3649 across 87 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 outpatient hospital claims. Medicare volume rose 7% from 2022 to 2024 (81 to 87 services). In 2024, 49 suppliers billed Medicare for L3649 (purchases), serving 64 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 | 1982-01-01 |
| Last action effective | 1999-01-01 |
Who bills L3649 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 49 |
| Referring clinicians | 60 |
| Medicare beneficiaries | 64 |
| States with claims | 1 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 55 | 60 |
| 2023 | 52 | 65 |
| 2024 | 49 | 64 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L3649, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 81 | 60 | $253.71 | $198.93 |
| 2023 | 91 | 65 | $234.92 | $184.18 |
| 2024 | 87 | 64 | $231.69 | $181.65 |
States with the most L3649 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Kentucky | 17 | $123.69 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 2 | 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 L3649
- 1982-01-01: L3649 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 L3649?
L3649 is the HCPCS Level II code for orthopedic shoe, modification, addition or transfer, not otherwise specified. Short descriptor: "Orthopedic shoe modifica nos".
How much does Medicare pay for L3649?
In 2024, the average Medicare payment was $181.65 per service (average allowed $231.69).
Does Medicare cover L3649?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for L3649?
Medicare policy articles that cite L3649 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 L3649 can be billed per day?
2 on outpatient hospital claims (NCCI medically unlikely edits).
Related L36 codes
- L3600 — Transfer of an orthosis from one shoe to another, caliper plate, existing ($91.55–$100.71)
- L3610 — Transfer of an orthosis from one shoe to another, caliper plate, new ($120.51–$132.57)
- L3620 — Transfer of an orthosis from one shoe to another, solid stirrup, existing ($91.55–$100.71)
- L3630 — Transfer of an orthosis from one shoe to another, solid stirrup, new ($120.51–$132.57)
- L3640 — Transfer of an orthosis from one shoe to another, dennis browne splint (riveton), both shoes ($51.86–$57.05)
- L3650 — Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf ($66.69–$105.67)
- L3660 — Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf ($112.56–$154.10)
- L3670 — Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf ($127.15–$215.52)
- L3671 — Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment ($983.68–$1,082.00)
- L3674 — Shoulder orthosis, abduction positioning (airplane design), thoracic component and support bar, with or without nontorsion joint/turnbuckle, may include soft interface, straps, custom fabricated, includes fitting and adjustment ($1,290.37–$1,419.42)
- L3675 — Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf ($191.58–$229.91)
- L3677 — Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
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 L3649
- Watch L3649 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L3649
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.