MyMedi-AI

L1906 — Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf

HCPCS Level II L-code · short descriptor: “Afo multilig ank sup 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
Required from 2026-10-28 (Orthoses)
MUE unit limit
2
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))

F2F + WOPD FROM 2026-10-28 L1906 joins Medicare's Required Face-to-Face & WOPD List for dates of service on or after 2026-10-28 (Orthoses — CMS-6109-N, 91 FR 47972 (published 2026-07-30)). From that date two extra conditions of payment apply:

  • Face-to-face encounter (in-person or telehealth) with the treating practitioner within the 6 months before the order date
  • Written order communicated to the supplier before delivery (WOPD)

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

L1906 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $138.20 to $318.48 depending on state and rural status.

Former-CBA payment limits: ceiling $184.26 · floor $138.20

StateNon-ruralRural
AK$297.85—
AL$157.92—
AR$138.20—
AZ$184.26—
CA$184.26—
CO$184.26—
CT$154.75—
DC$138.20—
DE$138.20—
FL$157.92—
GA$157.92—
HI$318.48—
IA$138.20—
ID$138.20—
IL$138.20—
IN$138.20—
KS$138.20—
KY$157.92—
LA$138.20—
MA$154.75—
MD$138.20—
ME$154.75—
MI$138.20—
MN$138.20—
MO$138.20—
MS$157.92—
MT$184.26—
NC$157.92—
ND$184.26—
NE$138.20—
NH$154.75—
NJ$139.58—
NM$138.20—
NV$184.26—
NY$139.58—
OH$138.20—
OK$138.20—
OR$138.20—
PA$138.20—
PR$142.76—
RI$154.75—
SC$157.92—
SD$184.26—
TN$157.92—
TX$138.20—
UT$184.26—
VA$138.20—
VI$139.66—
VT$154.75—
WA$138.20—
WI$138.20—
WV$138.20—
WY$184.26—
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 L1906 at 2 units per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: Anatomic Consideration.

Common denial codes to watch

Related L-codes

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