L4210 HCPCS code: Repair of orthotic device, repair or replace minor parts
L4210 is the HCPCS Level II code for repair of orthotic device, repair or replace minor parts. In 2024 Medicare paid an average of $39.24 per service for L4210 across 3,737 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 4 per day on DME suppliers. Medicare volume fell 20% from 2022 to 2024 (4,677 to 3,737 services). In 2024, 593 suppliers billed Medicare for L4210 (purchases), serving 2,122 beneficiaries; New York, Washington, Pennsylvania accounted for 28% of services.
Code details
| Field | Value |
|---|---|
| Section | L codes — Orthotic and prosthetic procedures and devices |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 46 — Priced by the Medicare contractor (no national fee) |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 1985-01-01 |
| Last action effective | 1996-01-01 |
Who bills L4210 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 593 |
| Referring clinicians | 1,903 |
| Medicare beneficiaries | 2,122 |
| States with claims | 35 |
| Share of services in top 3 states (New York, Washington, Pennsylvania) | 28% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 714 | 2,591 |
| 2023 | 672 | 2,387 |
| 2024 | 593 | 2,122 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L4210, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 4,677 | 2,591 | $45.80 | $34.56 |
| 2023 | 4,398 | 2,387 | $51.44 | $38.64 |
| 2024 | 3,737 | 2,122 | $52.48 | $39.24 |
States with the most L4210 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| New York | 386 | $43.23 |
| Washington | 313 | $33.46 |
| Pennsylvania | 293 | $36.55 |
| Minnesota | 254 | $21.33 |
| Massachusetts | 223 | $34.33 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 4 | Clinical: Data |
| outpatient hospital claims | 4 | Clinical: Data |
Medicare policy articles for this code
- A52457: Ankle-Foot/Knee-Ankle-Foot Orthoses - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
- A52465: Knee Orthoses - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (4,818 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| A52.16 | Charcot's arthropathy (tabetic) | 1 |
| E08.610 | Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy | 1 |
| E09.610 | Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy | 1 |
| E10.610 | Type 1 diabetes mellitus with diabetic neuropathic arthropathy | 1 |
| E11.610 | Type 2 diabetes mellitus with diabetic neuropathic arthropathy | 1 |
| G04.1 | Tropical spastic paraplegia | 1 |
| G35.A | Relapsing-remitting multiple sclerosis | 1 |
| G35.B0 | Primary progressive multiple sclerosis, unspecified | 1 |
| G35.B1 | Active primary progressive multiple sclerosis | 1 |
| G35.B2 | Non-active primary progressive multiple sclerosis | 1 |
Showing 10 of 4,818. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for L4210
- 1985-01-01: L4210 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 L4210?
L4210 is the HCPCS Level II code for repair of orthotic device, repair or replace minor parts. Short descriptor: "Orth dev repair/repl minor p".
How much does Medicare pay for L4210?
In 2024, the average Medicare payment was $39.24 per service (average allowed $52.48).
Does Medicare cover L4210?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for L4210?
Medicare policy articles that cite L4210 list 4,818 covered ICD-10-CM diagnosis codes across 2 articles. The most cited include A52.16 (Charcot's arthropathy (tabetic)), E08.610 (Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy), E09.610 (Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of L4210 can be billed per day?
4 on DME suppliers; 4 on outpatient hospital claims (NCCI medically unlikely edits).
Related L42 codes
- L4205 — Repair of orthotic device, labor component, per 15 minutes ($29.92–$49.16)
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 L4210
- Watch L4210 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L4210
Sources: CMS HCPCS Level II release October 2026; 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.