L3265 — Plastazote sandal, each
L3265 is a HCPCS Level II code for plastazote sandal, each. It belongs to the Orthotic and Prosthetic Procedures and Devices section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
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 L3265 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: Data
- DME supplier
- 0 — never payable 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 L3265
- Long descriptor
- Plastazote sandal, each
- Short descriptor
- Plastazote sandal each
- 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 L3265
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If L3265 is not quite right, the correct code is very often within a few positions of it.
- 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
- L3255Non-standard size or length
- L3257Orthopedic footwear, additional charge for split size
- L3260Surgical boot/shoe, 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
- L3334Lift, elevation, heel, per inch
- L3340Heel wedge, sach
- L3350Heel wedge
Questions about L3265
What is HCPCS code L3265?
L3265 is a HCPCS Level II code for plastazote sandal, each. It sits in the Orthotic and Prosthetic Procedures and Devices section.
Does Medicare cover L3265?
The CMS HCPCS file marks L3265 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.