Table of content for "Replace non-molded calf lace" (HCPCS L4055)
General information on the “L4055” code
HCPCS Code: L4055
Long Description: Replace non-molded calf lacer, for custom fabricated orthosis only
Short Description: Replace non-molded calf lace
Original information is taken from L4055 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: 19880101
Code Effective Date: 20050101
Action Code: N – No maintenance for this code