MyMedi-AI

L0980 — Peroneal straps, prefabricated, off-the-shelf, pair

HCPCS Level II L-code · short descriptor: “Peroneal straps pair pre ots”

Code system
HCPCS Level II
Family
L — Orthotics & prosthetics
Medicare coverage status
Carrier judgment — coverage decided by the DME MAC
DMEPOS payment category
Prosthetics & orthotics
Prior authorization
Not on Medicare required-PA list
Face-to-face & WOPD
Not on the required list
MUE unit limit
1
Status
Active (HCPCS Level II October 2026)

Prior authorization

Not on the Medicare required-PA list (CMS Required Prior Authorization List — 74 items in force on 2026-10-25; 8 more from 2026-10-28; sources: CMS list updated 2026-01-13, CMS-6109-N (91 FR 47972)). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.

Order readiness — what the written order must contain

Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):

  • Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
  • General description of the item (42 CFR 410.38(d)(1)(i)(B))
  • Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
  • Order date (42 CFR 410.38(d)(1)(i)(D))
  • Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
  • Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))

Not on the F2F/WOPD list (CMS Required F2F & WOPD List — 83 items in force on 2026-10-25; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). The standard written order must reach the supplier before claim submission.

Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.

L0980 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $16.07 to $26.75 depending on state and rural status.

Former-CBA payment limits: ceiling $26.75 · floor $20.07

StateNon-ruralRural
AK$16.07—
AL$20.07—
AR$26.75—
AZ$20.07—
CA$20.07—
CO$20.07—
CT$26.75—
DC$26.47—
DE$26.47—
FL$20.07—
GA$20.07—
HI$17.15—
IA$20.07—
ID$21.34—
IL$20.99—
IN$20.99—
KS$20.07—
KY$20.07—
LA$26.75—
MA$26.75—
MD$26.47—
ME$26.75—
MI$20.99—
MN$20.99—
MO$20.07—
MS$20.07—
MT$20.07—
NC$20.07—
ND$20.07—
NE$20.07—
NH$26.75—
NJ$20.07—
NM$26.75—
NV$20.07—
NY$20.07—
OH$20.99—
OK$26.75—
OR$21.34—
PA$26.47—
PR$17.45—
RI$26.75—
SC$20.07—
SD$20.07—
TN$20.07—
TX$26.75—
UT$20.07—
VA$26.47—
VI$20.07—
VT$26.75—
WA$21.34—
WI$20.99—
WV$26.47—
WY$20.07—
Amounts are the Medicare DMEPOS fee-schedule allowables effective October 2026 (CMS DMEPOS Fee Schedule October 2026 (DME26-D)). 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.

Unit limit (MUE)

Medicare's Medically Unlikely Edit caps L0980 at 1 unit per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: Code Descriptor / CPT Instruction.

Common denial codes to watch

Related L-codes

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