Table of content for "Whfo electric custom fitted" (HCPCS L3904)
General information on the “L3904” code
HCPCS Code: L3904
Long Description: Wrist hand finger orthosis, external powered, electric, custom fabricated
Short Description: Whfo electric custom fitted
Original information is taken from L3904 page
Pricing indicators
Pricing Indicator Code 1: 38 – Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) . Durable Medical Equipment, Prosthetics, Orthotics, Supplies And Surgical Dressings
Multiple Pricing Indicator Code A : Not applicable as HCPCS priced under one methodology
Certification and additional reference information
Coverage
Coverage: C – Carrier judgment
Type of service
Berenson-Eggers Type of Service (BETOS): D1F – Prosthetic/Orthotic devices
Type Of Service 1: P – Lump sum purchase of DME, prosthetics, orthotics
Misc information
Anesthesia Base Unit Quantity: 0
Code Added Date: 19820101
Code Effective Date: 20010101
Action Code: N – No maintenance for this code