Labor Payment Rates

When an orthosis or prosthesis must be repaired, and is no longer under warranty, there are specific labor and parts codes you can use on the claim.

Cost of labor:

L4205 REPAIR OF ORTHOTIC DEVICE, LABOR COMPONENT, PER 15 MINUTES*

L7520 REPAIR PROSTHETIC DEVICE, LABOR COMPONENT, PER 15 MINUTES*

*Bill these codes in 15-minute increments for actual time involved in repairs.

The labor payment rates, per 15 minute increments, are listed on the Nordian website.

Cost of parts:

HCPCS code of the base product AND

L4210 REPAIR OF ORTHOTIC DEVICE, REPAIR OR REPLACE MINOR PARTS

L7510 REPAIR OF PROSTHETIC DEVICE, REPAIR OR REPLACE MINOR PARTS

When billing one of the repair codes, you must explain what you are repairing and provide a narrative description of the base items. You should also document how long the repairs took. For the claim, enter the explanation of repair in Item 19 on the HCFA 1500 or its electronic equivalent. The box 19 field is limited to 71 characters, so it is necessary to be concise and use abbreviations. Provide sufficient explanation of the time and repairs and parts used.

Medically Unlikely Edits (MUE) are active for the repair codes. This means the Medicare claims processing software may automatically deny the claim after a certain number of units. For L4205 the number of units is eight. For L7520, the number of units is 12. 

What does this mean for you?

You can provide necessary repairs for your patients and bill for time and materials. Be sure to document the time involved, the details of the repair, and the specific parts used.