L3995 HCPCS code: Addition to upper extremity orthosis, sock, fracture or equal, each
L3995 is the HCPCS Level II code for addition to upper extremity orthosis, sock, fracture or equal, each. The 2026 Medicare DMEPOS fee schedule pays $36.77 to $57.10 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 4 per day on DME suppliers. Medicare volume fell 5% from 2022 to 2024 (5,954 to 5,668 services). In 2024, 465 suppliers billed Medicare for L3995 (purchases), serving 4,341 beneficiaries; New York, California, Texas accounted for 48% of services. Its average fee ranks 2 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 | 1989-01-01 |
| Last action effective | 1996-01-01 |
2026 Medicare DMEPOS fee schedule for L3995
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $36.77 | $57.10 | $49.02 | $36.77 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $44.22 | — |
| AL | — | $38.45 | — |
| AR | — | $47.94 | — |
| AZ | — | $42.85 | — |
| CA | — | $42.85 | — |
| CO | — | $36.77 | — |
| CT | — | $49.02 | — |
| DC | — | $40.11 | — |
| DE | — | $40.11 | — |
| FL | — | $38.45 | — |
| GA | — | $38.45 | — |
| HI | — | $47.30 | — |
| IA | — | $36.77 | — |
| ID | — | $40.82 | — |
| IL | — | $45.92 | — |
| IN | — | $45.92 | — |
| KS | — | $36.77 | — |
| KY | — | $38.45 | — |
| LA | — | $47.94 | — |
| MA | — | $49.02 | — |
| MD | — | $40.11 | — |
| ME | — | $49.02 | — |
| MI | — | $45.92 | — |
| MN | — | $45.92 | — |
| MO | — | $36.77 | — |
| MS | — | $38.45 | — |
| MT | — | $36.77 | — |
| NC | — | $38.45 | — |
| ND | — | $36.77 | — |
| NE | — | $36.77 | — |
| NH | — | $49.02 | — |
| NJ | — | $49.02 | — |
| NM | — | $47.94 | — |
| NV | — | $42.85 | — |
| NY | — | $49.02 | — |
| OH | — | $45.92 | — |
| OK | — | $47.94 | — |
| OR | — | $40.82 | — |
| PA | — | $40.11 | — |
| PR | — | $57.10 | — |
| RI | — | $49.02 | — |
| SC | — | $38.45 | — |
| SD | — | $36.77 | — |
| TN | — | $38.45 | — |
| TX | — | $47.94 | — |
| UT | — | $36.77 | — |
| VA | — | $40.11 | — |
| VI | — | $49.02 | — |
| VT | — | $49.02 | — |
| WA | — | $40.82 | — |
| WI | — | $45.92 | — |
| WV | — | $40.11 | — |
| WY | — | $36.77 | — |
How the L3995 fee compares
| Measure | Value |
|---|---|
| Rank among 38 L39 codes (lowest = 1) | 2 |
| Family fee range (average of state fees) | $38.92–$3,752.58 |
| Rural fee uplift | — |
Who bills L3995 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 465 |
| Referring clinicians | 1,707 |
| Medicare beneficiaries | 4,341 |
| States with claims | 39 |
| Share of services in top 3 states (New York, California, Texas) | 48% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 510 | 4,277 |
| 2023 | 485 | 4,036 |
| 2024 | 465 | 4,341 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L3995, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 5,954 | 4,277 | $38.03 | $29.59 |
| 2023 | 5,559 | 4,036 | $40.91 | $31.56 |
| 2024 | 5,668 | 4,341 | $42.14 | $32.26 |
States with the most L3995 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| New York | 1,627 | $35.77 |
| California | 738 | $31.86 |
| Texas | 322 | $34.87 |
| New Jersey | 312 | $32.75 |
| Florida | 243 | $28.58 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 4 | Nature of Equipment |
| outpatient hospital claims | 4 | Nature of Equipment |
What changed for L3995
- 2026-01-01: Average state fee rose 2.0%: $42.03 to $42.87
- 1989-01-01: L3995 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 L3995?
L3995 is the HCPCS Level II code for addition to upper extremity orthosis, sock, fracture or equal, each. Short descriptor: "Sock fracture or equal each".
How much does Medicare pay for L3995?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $36.77–$57.10. Rural fees can be higher.
Does Medicare cover L3995?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L3995 change in 2026?
The average non-rural state fee moved from $42.03 in 2025 to $42.87 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L3995 can be billed per day?
4 on DME suppliers; 4 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 L3995
- Watch L3995 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L3995
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.