L3961 HCPCS code: Shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3961 is the HCPCS Level II code for shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment. The 2026 Medicare DMEPOS fee schedule pays $1,834.09 to $2,017.52 depending on the state. 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 DME suppliers. Medicare volume rose 17% from 2022 to 2024 (46 to 54 services). In 2024, 4 suppliers billed Medicare for L3961 (purchases), serving 54 beneficiaries. Its average fee ranks 29 of 38 L39 codes (family range $38.92–$3,752.58).
Code details
| Field | Value |
|---|---|
| Section | L codes — Orthotic and prosthetic procedures and devices |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 38 — DMEPOS: orthotics, prosthetics, prosthetic devices and vision services |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 2006-01-01 |
| Last action effective | 2006-01-01 |
2026 Medicare DMEPOS fee schedule for L3961
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $1,834.09 | $2,017.52 | $2,238.26 | $1,678.69 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $1,834.09 | — |
| AL | — | $1,889.33 | — |
| AR | — | $1,889.14 | — |
| AZ | — | $1,834.09 | — |
| CA | — | $1,834.09 | — |
| CO | — | $1,899.76 | — |
| CT | — | $1,834.09 | — |
| DC | — | $1,834.09 | — |
| DE | — | $1,834.09 | — |
| FL | — | $1,889.33 | — |
| GA | — | $1,889.33 | — |
| HI | — | $1,834.09 | — |
| IA | — | $1,869.94 | — |
| ID | — | $1,834.09 | — |
| IL | — | $1,879.17 | — |
| IN | — | $1,879.17 | — |
| KS | — | $1,869.94 | — |
| KY | — | $1,889.33 | — |
| LA | — | $1,889.14 | — |
| MA | — | $1,834.09 | — |
| MD | — | $1,834.09 | — |
| ME | — | $1,834.09 | — |
| MI | — | $1,879.17 | — |
| MN | — | $1,879.17 | — |
| MO | — | $1,869.94 | — |
| MS | — | $1,889.33 | — |
| MT | — | $1,899.76 | — |
| NC | — | $1,889.33 | — |
| ND | — | $1,899.76 | — |
| NE | — | $1,869.94 | — |
| NH | — | $1,834.09 | — |
| NJ | — | $1,834.09 | — |
| NM | — | $1,889.14 | — |
| NV | — | $1,834.09 | — |
| NY | — | $1,834.09 | — |
| OH | — | $1,879.17 | — |
| OK | — | $1,889.14 | — |
| OR | — | $1,834.09 | — |
| PA | — | $1,834.09 | — |
| PR | — | $2,017.52 | — |
| RI | — | $1,834.09 | — |
| SC | — | $1,889.33 | — |
| SD | — | $1,899.76 | — |
| TN | — | $1,889.33 | — |
| TX | — | $1,889.14 | — |
| UT | — | $1,899.76 | — |
| VA | — | $1,834.09 | — |
| VI | — | $2,017.52 | — |
| VT | — | $1,834.09 | — |
| WA | — | $1,834.09 | — |
| WI | — | $1,879.17 | — |
| WV | — | $1,834.09 | — |
| WY | — | $1,899.76 | — |
How the L3961 fee compares
| Measure | Value |
|---|---|
| Rank among 38 L39 codes (lowest = 1) | 29 |
| Family fee range (average of state fees) | $38.92–$3,752.58 |
| Rural fee uplift | — |
Who bills L3961 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 4 |
| Referring clinicians | 18 |
| Medicare beneficiaries | 54 |
| States with claims | 1 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 6 | 46 |
| 2023 | 3 | 43 |
| 2024 | 4 | 54 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L3961, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 46 | 46 | $1,510.33 | $1,194.08 |
| 2023 | 44 | 43 | $1,690.36 | $1,325.24 |
| 2024 | 54 | 54 | $1,744.71 | $1,367.84 |
States with the most L3961 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 45 | $1,378.70 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1 | Nature of Equipment |
| outpatient hospital claims | 1 | Nature of Equipment |
What changed for L3961
- 2026-01-01: Average state fee rose 2.0%: $1,833.12 to $1,869.79
- 2006-01-01: L3961 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 L3961?
L3961 is the HCPCS Level II code for shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment. Short descriptor: "Sewho cap design w/o jnts cf".
How much does Medicare pay for L3961?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $1,834.09–$2,017.52. Rural fees can be higher.
Does Medicare cover L3961?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L3961 change in 2026?
The average non-rural state fee moved from $1,833.12 in 2025 to $1,869.79 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L3961 can be billed per day?
1 on DME suppliers; 1 on outpatient hospital claims (NCCI medically unlikely edits).
Related L39 codes
- L3900 — Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, wrist or finger driven, custom fabricated ($920.35–$1,941.24)
- L3901 — Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom fabricated ($1,227.04–$2,394.77)
- L3904 — Wrist hand finger orthosis, external powered, electric, custom fabricated ($2,345.68–$6,383.35)
- L3905 — Wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment ($1,082.62–$1,190.84)
- L3906 — Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment ($380.72–$650.39)
- L3908 — Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf ($49.93–$125.86)
- L3912 — Hand finger orthosis (hfo), flexion glove with elastic finger control, prefabricated, off-the-shelf ($65.50–$172.42)
- L3913 — Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment ($295.66–$325.21)
- L3915 — Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, 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 ($580.28–$638.37)
- L3916 — Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf ($580.28–$638.37)
- L3917 — Hand orthosis, metacarpal fracture orthosis, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise ($115.37–$126.80)
- L3918 — Hand orthosis, metacarpal fracture orthosis, prefabricated, off-the-shelf ($115.37–$126.80)
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 L3961
- Watch L3961 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L3961
Sources: CMS HCPCS Level II release October 2026; 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.