L3255: Non-standard size or length
L3255 is a HCPCS Level II code for non-standard size or length. 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 2026Q4-Oct. This states Medicare’s position on the code, not on your particular claim.
Medically Unlikely Edits: units per day
The most units of L3255 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 2026Q4.
The CMS record for L3255
- Long descriptor
- Non-standard size or length
- Short descriptor
- Orth foot non-standard size/
- 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 L3255
HCPCS has no hierarchy: related items simply sit next to each other in the numbering. If L3255 is not quite right, the correct code is very often within a few positions of it.
- 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
- L3250Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, 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
- L3257Orthopedic footwear, additional charge for split size
- L3260Surgical boot/shoe, each
- L3265Plastazote sandal, each
- L3300Lift, elevation, heel, tapered to metatarsals, per inch
- L3310Lift, elevation, heel and sole, neoprene, per inch
- L3320Lift, elevation, heel and sole, cork, per inch
- L3330Lift, elevation, metal extension (skate)
- L3332Lift, elevation, inside shoe, tapered, up to one-half inch