2025 HCPCS Code L1904
Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated
TAGS: gauntlet custom fabricated ankle| Short Description | Afo molded ankle gauntlet |
| HCPCS Action Code | N - No maintenance for this code |
| HCPCS Coverage Code | C - Carrier judgment |
| HCPCS Code Added Date | January 01, 1988 |
| HCPCS Action Effective Date | January 01, 2016 |
| HCPCS Pricing Indicator Code | 38 - Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) |
| HCPCS Type Of Service Code | P - Lump sum purchase of DME, prosthetics, orthotics |
| HCPCS Multiple Pricing Indicator Code | A - Not applicable as HCPCS priced under one methodology |
| HCPCS Anesthesia Base Unit Quantity | 0 |
| HCPCS Coverage Issues Manual Reference Section Number |
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