L3255 – Non-standard size or length
HCPCS Level II code · L codes: Orthotic and Prosthetic Procedures and Devices
HCPCS codeL3255
- Long description
- Non-standard size or length
- Short description
- Orth foot non-standard size/
- Pricing indicator
00Not separately priced by Part B (bundled, not covered or Part A only)- Medicare coverage
DSpecial coverage instructions apply- BETOS category
D1FProsthetic/Orthotic devices- Added
- January 1, 1984
- Last change
- January 1, 1997 – No change
Frequently asked questions
What is HCPCS code L3255?
L3255 is a HCPCS Level II code for non-standard size or length.
Does Medicare cover L3255?
The HCPCS file lists coverage code D: Special coverage instructions apply. Coverage and payment also depend on local coverage determinations and the patient’s plan.
Nearby L codes
- L3224 – Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthosis)
- L3225 – Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis)
- L3230 – Orthopedic footwear, custom shoe, depth inlay, each
- L3250 – Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each
- L3251 – Foot, shoe molded to patient model, silicone shoe, each
- L3252 – Foot, shoe molded to patient model, plastazote (or similar), custom fabricated, each
- L3253 – Foot, molded shoe plastazote (or similar) custom fitted, each
- L3254 – Non-standard size or width
- L3257 – Orthopedic footwear, additional charge for split size
- L3260 – Surgical boot/shoe, each
- L3265 – Plastazote sandal, each
- L3300 – Lift, elevation, heel, tapered to metatarsals, per inch
- L3310 – Lift, elevation, heel and sole, neoprene, per inch
- L3320 – Lift, elevation, heel and sole, cork, per inch
- L3330 – Lift, elevation, metal extension (skate)
- L3332 – Lift, elevation, inside shoe, tapered, up to one-half inch
Source: CMS HCPCS Level II quarterly file, October 2026. Reference only – check payer policy before billing.