L3677 — Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L3677 is a HCPCS Level II code for shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise. 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 L3677 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 2 — Date of Service Edit: Policy · Code Descriptor / CPT Instruction
- DME supplier
- 1 unit MAI 2 — Date of Service Edit: Policy · Code Descriptor / CPT Instruction
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 L3677
- Long descriptor
- Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
- Short descriptor
- So hard plas stabili pre cst
- Added
- January 1, 2002
- BETOS
- Z2
- 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 L3677
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If L3677 is not quite right, the correct code is very often within a few positions of it.
- L3640Transfer of an orthosis from one shoe to another, dennis browne splint (riveton), both shoes
- L3649Orthopedic shoe, modification, addition or transfer, not otherwise specified
- L3650Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf
- L3660Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf
- L3670Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf
- L3671Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
- L3674Shoulder orthosis, abduction positioning (airplane design), thoracic component and support bar, with or without nontorsion joint/turnbuckle, may include soft interface, straps, custom fabricated, includes fitting and adjustment
- L3675Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf
- L3678Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated, off-the-shelf
- L3702Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
- L3710Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf
- L3720Elbow orthosis, double upright with forearm/arm cuffs, free motion, custom fabricated
- L3730Elbow orthosis, double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated
- L3740Elbow orthosis, double upright with forearm/arm cuffs, adjustable position lock with active control, custom fabricated
- L3760Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
- L3761Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, off-the-shelf
Questions about L3677
What is HCPCS code L3677?
L3677 is a HCPCS Level II code for shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise. It sits in the Orthotic and Prosthetic Procedures and Devices section.
Does Medicare cover L3677?
The CMS HCPCS file marks L3677 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.