L3204 — Orthopedic shoe, hightop with supinator or pronator, infant
L3204 is a HCPCS Level II code for orthopedic shoe, hightop with supinator or pronator, infant. It belongs to the Orthotic and Prosthetic Procedures and Devices section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Special coverage instructions apply
There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Medically Unlikely Edits — units per day
The most units of L3204 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
- outpatient
- 1 unit MAI 3 — Date of Service Edit: Clinical · Clinical: CMS Workgroup
- DME supplier
- 1 unit MAI 3 — Date of Service Edit: Clinical · Clinical: CMS Workgroup
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for L3204
- Long descriptor
- Orthopedic shoe, hightop with supinator or pronator, infant
- Short descriptor
- Hightop w/ supp/pronator inf
- Added
- January 1, 1984
- BETOS
- D1F
- Pricing indicator
- 00 — Not priced by Part B
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Service not separately priced by Part B — not covered, bundled into another service, or used by Part A only.
Codes adjacent to L3204
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If L3204 is not quite right, the correct code is very often within a few positions of it.
- L3140Foot, abduction rotation bar, including shoes
- L3150Foot, abduction rotation bar, without shoes
- L3160Foot, adjustable shoe-styled positioning device
- L3161Foot, adductus positioning device, adjustable
- L3170Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each
- L3201Orthopedic shoe, oxford with supinator or pronator, infant
- L3202Orthopedic shoe, oxford with supinator or pronator, child
- L3203Orthopedic shoe, oxford with supinator or pronator, junior
- L3206Orthopedic shoe, hightop with supinator or pronator, child
- L3207Orthopedic shoe, hightop with supinator or pronator, junior
- L3208Surgical boot, each, infant
- L3209Surgical boot, each, child
- L3211Surgical boot, each, junior
- L3212Benesch boot, pair, infant
- L3213Benesch boot, pair, child
- L3214Benesch boot, pair, junior
Questions about L3204
What is HCPCS code L3204?
L3204 is a HCPCS Level II code for orthopedic shoe, hightop with supinator or pronator, infant. It sits in the Orthotic and Prosthetic Procedures and Devices section.
Does Medicare cover L3204?
The CMS HCPCS file marks L3204 as "Special coverage instructions apply". There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.