L3530 — Orthopedic shoe addition, sole, half
HCPCS Level II L-code · short descriptor: “Ortho shoe add half sole”
- Code system
- HCPCS Level II
- Family
- L — Orthotics & prosthetics
- Medicare coverage status
- Special coverage instructions apply
- DMEPOS payment category
- Prosthetics & orthotics
- Prior authorization
- Not on Medicare required-PA list
- Status
- Active (April 2026 HCPCS)
Prior authorization
Not on the Medicare required-PA list as of the January 13, 2026 update (74 items). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.
L3530 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $38.11 to $41.95 depending on state and rural status.
Former-CBA payment limits: ceiling $46.52 · floor $34.89
| State | Non-rural | Rural |
|---|---|---|
| AK | $38.11 | — |
| AL | $39.28 | — |
| AR | $39.27 | — |
| AZ | $38.11 | — |
| CA | $38.11 | — |
| CO | $39.50 | — |
| CT | $38.11 | — |
| DC | $38.11 | — |
| DE | $38.11 | — |
| FL | $39.28 | — |
| GA | $39.28 | — |
| HI | $38.11 | — |
| IA | $38.87 | — |
| ID | $38.11 | — |
| IL | $39.08 | — |
| IN | $39.08 | — |
| KS | $38.87 | — |
| KY | $39.28 | — |
| LA | $39.27 | — |
| MA | $38.11 | — |
| MD | $38.11 | — |
| ME | $38.11 | — |
| MI | $39.08 | — |
| MN | $39.08 | — |
| MO | $38.87 | — |
| MS | $39.28 | — |
| MT | $39.50 | — |
| NC | $39.28 | — |
| ND | $39.50 | — |
| NE | $38.87 | — |
| NH | $38.11 | — |
| NJ | $38.11 | — |
| NM | $39.27 | — |
| NV | $38.11 | — |
| NY | $38.11 | — |
| OH | $39.08 | — |
| OK | $39.27 | — |
| OR | $38.11 | — |
| PA | $38.11 | — |
| PR | $41.95 | — |
| RI | $38.11 | — |
| SC | $39.28 | — |
| SD | $39.50 | — |
| TN | $39.28 | — |
| TX | $39.27 | — |
| UT | $39.50 | — |
| VA | $38.11 | — |
| VI | $41.95 | — |
| VT | $38.11 | — |
| WA | $38.11 | — |
| WI | $39.08 | — |
| WV | $38.11 | — |
| WY | $39.50 | — |
Amounts are the Medicare DMEPOS fee-schedule allowables effective April 2026.
Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%.
A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area
adjustments and non-continental rates can differ — verify with your DME MAC.
Common denial codes to watch
Related L-codes
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