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L3960 |
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Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment
| short | Sewho airplan desig abdu pos |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
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L3961 |
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Shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
| short | Sewho cap design w/o jnts cf |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
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L3962 |
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Shoulder elbow wrist hand orthosis, abduction positioning, erb's palsey design, prefabricated, includes fitting and adjustment
| short | Sewho erbs palsey design abd |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
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L3967 |
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Shoulder elbow wrist hand orthosis, abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
| short | Sewho airplane w/o jnts cf |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
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L3971 |
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Shoulder elbow wrist hand orthosis, shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
| short | Sewho cap design w/jnt(s) cf |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
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L3973 |
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Shoulder elbow wrist hand orthosis, abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
| short | Sewho airplane w/jnt(s) cf |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
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