Custom Splinting & Orthotic L-Codes: A Practical Guide for Therapists

Custom orthotic fabrication is a core skill in hand therapy, yet billing for splints remains confusing, inconsistent, and poorly explained in most continuing education resources. This post is designed specifically for therapists who fabricate custom orthoses during therapy sessions and need clarity on:

• Which L-codes apply to which splints

• When to bill an orthotic initial encounter vs orthotic management/training

• How common hand and upper extremity splints are categorized from a coding standpoint

Important disclaimer: Payer policies vary. This guide reflects standard Medicare-based definitions, which most commercial insurers loosely follow. Always confirm payer-specific rules.

Orthotic Coding: Two Separate Components

When you fabricate a custom splint, you are typically billing for two different things:

A. The Orthosis Itself → L-Code

• Covers materials, fabrication, and fitting

• Billed once per orthosis

• Applies only to custom-fabricated splints (not prefab)

B. The Therapy Time → CPT Codes

• Covers training, modification, wear schedule, education

• Billed as initial encounter or subsequent management

These should not be confused or bundled incorrectly.

Orthotic Management CPT Codes (When to Use Each)

97760 – Orthotic Management & Training, Initial Encounter

Use once per orthosis when:

• A new custom splint is fabricated and issued

• You provide initial fitting, education, donning/doffing, wear schedule

• Minor modifications are performed at delivery

Typically billed same day as the L-code- Time-based (15-minute units)

97763 – Orthotic Management & Training, Subsequent Encounter

Use for follow-up visits involving:

• Splint modifications

• Re-education

• Strap changes, remolding, padding adjustments

• Wear schedule progression

Do not bill 97760 again for the same orthosis- This code replaces the old 97762

Custom Upper Extremity Orthotic L-Code Categories

Below is where most confusion exists. L-codes are determined by joint coverage, not splint purpose.

Custom Finger Orthosis

L3933

Descriptor: Finger orthosis, custom fabricated

Covers splints that include:

• One finger

• MCP, PIP, and/or DIP joints

• No wrist or hand component

Common Examples:

• Relative motion orthosis (single finger)

• Finger gutter splint

• PIP extension splint

• DIP mallet splint

• Trigger finger MCP blocking splint (finger-only)

Custom Hand & Finger Orthosis (No Wrist)

L3913

Descriptor: Hand-finger orthosis, custom fabricated

Covers splints that include:

• One or more fingers and

• A hand-based component

• No wrist immobilization

Common Examples:

• Hand-based MCP lumbrical block splint

• Short opponens splint (thumb CMC stabilization)

• Hand-based thumb spica (no wrist)

• Multi-finger relative motion orthosis with hand base

Custom Wrist Orthosis

L3906

Descriptor: Wrist orthosis, custom fabricated

Covers splints that include:

• Wrist only

• No hand or finger positioning beyond strapping

Common Examples:

• Wrist cock-up splint

• Volar wrist immobilization splint

• Dorsal wrist extension splint

Custom Hand–Wrist–Finger Orthosis

L3808

Descriptor: Hand-wrist-finger orthosis, custom fabricated

Covers splints that include:

• Wrist and

• Hand and/or fingers

Common Examples:

• Long opponens splint (thumb spica with wrist)

• Resting hand splint

• Forearm-based MCP extension or flexion blocking splint

• Dynamic finger extension splint with wrist base

4. Common Splints & Their Correct Coding

Splint Type	Correct L-Code
Wrist cock-up	L3906
Short opponens splint	L3913
Long opponens splint	L3808
Resting hand splint	L3808
Hand-based MCP lumbrical block	L3913
Relative motion orthosis (single finger)	L3933
Relative motion orthosis (hand-based)	L3913
Mallet finger splint	L3933
Trigger finger MCP block (finger-only)	L3933

Custom Orthotic L-Code Cheat Sheet for Therapists.pdf

Download PDF • 73KB

Key Billing Principles Therapists Miss

• L-codes are not time-based

• 97760 is billed once per orthosis, not per visit

• 97763 is used for all follow-ups and modifications

• If you fabricate two distinct orthoses, each may have:

  • Its own L-code

  • Its own 97760 (if clinically justified)

Documentation Tips to Protect Yourself

Your note should clearly include:

• Diagnosis supporting splint need

• Statement that orthosis is custom fabricated

• Joints included (finger vs hand vs wrist)

• Patient education provided

• Medical necessity (protection, alignment, pain reduction, function)

Avoid vague language like “splint made”—be specific.

Final Thoughts

Custom orthotic fabrication is skilled therapy, not an accessory service. Understanding how splints are categorized and billed allows therapists to:

• Stay compliant

• Advocate for the value of hand therapy

• Avoid underbilling or denied claims

If you fabricate splints regularly, mastering L-codes is just as important as mastering thermoplastic.