HCPCS Code L3260

Official Description

Surgical boot/shoe, each

Short Descr	Ambulatory surgical boot eac
Coverage	Special coverage instructions apply
Pricing Indicator(s)	00 – Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.)
MPI	9 – Not applicable, as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is '99')
MCM	2079
BETOS	D1F – Prosthetic/Orthotic devices
TOS Code(s)	P – Lump sum purchase of DME, prosthetics, orthotics
Added Date	1/1/1984
APC Status Indicator	Non-Covered Service, not paid under OPPS
MUE	0
MUE	0
IOM	100-02, 15, 100
OTS Orthotic	No
CCS Clinical Classification	243 - DME and supplies

LT	Left side (used to identify procedures performed on the left side of the body)
GY	Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
RT	Right side (used to identify procedures performed on the right side of the body)
KX	Requirements specified in the medical policy have been met
GA	Waiver of liability statement issued as required by payer policy, individual case
GX	Notice of liability issued, voluntary under payer policy
GZ	Item or service expected to be denied as not reasonable and necessary
KV	Dmepos item subject to dmepos competitive bidding program that is furnished as part of a professional service
NU	New equipment
50	Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
58	Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
59	Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
79	Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
BL	Special acquisition of blood and blood products
CC	Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
CG	Policy criteria applied
CR	Catastrophe/disaster related
EY	No physician or other licensed health care provider order for this item or service
FT	Unrelated evaluation and management (e/m) visit on the same day as another e/m visit or during a global procedure (preoperative, postoperative period, or on the same day as the procedure, as applicable). (report when an e/m visit is furnished within the global period but is unrelated, or when one or more additional e/m visits furnished on the same day are unrelated)
FY	X-ray taken using computed radiography technology/cassette-based imaging
GC	This service has been performed in part by a resident under the direction of a teaching physician
GP	Services delivered under an outpatient physical therapy plan of care
GT	Via interactive audio and video telecommunication systems
GV	Attending physician not employed or paid under arrangement by the patient's hospice provider
GW	Service not related to the hospice patient's terminal condition
KS	Glucose monitor supply for diabetic beneficiary not treated with insulin
KT	Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item
KY	Dmepos item subject to dmepos competitive bidding program number 5
LR	Laboratory round trip
Q6	Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
QK	Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals
RA	Replacement of a dme, orthotic or prosthetic item
SL	State supplied vaccine
ST	Related to trauma or injury
T2	Left foot, third digit
T3	Left foot, fourth digit
T4	Left foot, fifth digit
T5	Right foot, great toe
TA	Left foot, great toe
TC	Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles
XE	Separate encounter, a service that is distinct because it occurred during a separate encounter
XS	Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU	Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service