MyMedi-AI

L1907 — Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated

HCPCS Level II L-code · short descriptor: “Afo supramalleolar custom”

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
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))

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.

L1907 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $674.95 to $742.46 depending on state and rural status.

Former-CBA payment limits: ceiling $823.67 · floor $617.76

StateNon-ruralRural
AK$674.95—
AL$695.27—
AR$695.21—
AZ$674.95—
CA$674.95—
CO$699.09—
CT$674.95—
DC$674.95—
DE$674.95—
FL$695.27—
GA$695.27—
HI$674.95—
IA$688.07—
ID$674.95—
IL$691.55—
IN$691.55—
KS$688.07—
KY$695.27—
LA$695.21—
MA$674.95—
MD$674.95—
ME$674.95—
MI$691.55—
MN$691.55—
MO$688.07—
MS$695.27—
MT$699.09—
NC$695.27—
ND$699.09—
NE$688.07—
NH$674.95—
NJ$674.95—
NM$695.21—
NV$674.95—
NY$674.95—
OH$691.55—
OK$695.21—
OR$674.95—
PA$674.95—
PR$742.46—
RI$674.95—
SC$695.27—
SD$699.09—
TN$695.27—
TX$695.21—
UT$699.09—
VA$674.95—
VI$742.46—
VT$674.95—
WA$674.95—
WI$691.55—
WV$674.95—
WY$699.09—
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 L1907 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

Bill L1907 with confidence

Track prior-authorization requests with AI pre-fill and deadline tracking, and draft PA appeal letters — built for DME teams, PHI-free: no patient data is collected or stored.

Start free trial   Run a CMS-0057-F readiness check

Prefer DIY compliance? Self-audit documentation kits for DME suppliers →

Building an AI agent? Try the agent API in the playground — free PA-required lookups, L1907 included, and starter credits via POST /bot-marketplace/register.