L3250 — Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each
L3250 is a HCPCS Level II code for orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each. 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 L3250 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
- 2 units MAI 2 — Date of Service Edit: Policy · Anatomic Consideration
- DME supplier
- 2 units MAI 2 — Date of Service Edit: Policy · Anatomic Consideration
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 L3250
- Long descriptor
- Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each
- Short descriptor
- Custom mold shoe remov prost
- 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 L3250
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If L3250 is not quite right, the correct code is very often within a few positions of it.
- L3216Orthopedic footwear, ladies shoe, depth inlay, each
- L3217Orthopedic footwear, ladies shoe, hightop, depth inlay, each
- L3219Orthopedic footwear, mens shoe, oxford, each
- L3221Orthopedic footwear, mens shoe, depth inlay, each
- L3222Orthopedic footwear, mens shoe, hightop, depth inlay, each
- L3224Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthosis)
- L3225Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis)
- L3230Orthopedic footwear, custom shoe, depth inlay, each
- L3251Foot, shoe molded to patient model, silicone shoe, each
- L3252Foot, shoe molded to patient model, plastazote (or similar), custom fabricated, each
- L3253Foot, molded shoe plastazote (or similar) custom fitted, each
- L3254Non-standard size or width
- L3255Non-standard size or length
- L3257Orthopedic footwear, additional charge for split size
- L3260Surgical boot/shoe, each
- L3265Plastazote sandal, each
Questions about L3250
What is HCPCS code L3250?
L3250 is a HCPCS Level II code for orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each. It sits in the Orthotic and Prosthetic Procedures and Devices section.
Does Medicare cover L3250?
The CMS HCPCS file marks L3250 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.