L1920 — Ankle foot orthosis, single upright with static or adjustable stop (phelps or perlstein type), custom fabricated
HCPCS Level II L-code · short descriptor: “Afo sing upright w/ adjust s”
- 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
- 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.
L1920 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $374.16 to $761.40 depending on state and rural status.
Former-CBA payment limits: ceiling $535.64 · floor $401.73
| State | Non-rural | Rural |
|---|---|---|
| AK | $374.16 | — |
| AL | $401.73 | — |
| AR | $415.96 | — |
| AZ | $418.92 | — |
| CA | $418.92 | — |
| CO | $505.28 | — |
| CT | $533.93 | — |
| DC | $401.73 | — |
| DE | $401.73 | — |
| FL | $401.73 | — |
| GA | $401.73 | — |
| HI | $400.10 | — |
| IA | $401.73 | — |
| ID | $514.91 | — |
| IL | $504.86 | — |
| IN | $504.86 | — |
| KS | $401.73 | — |
| KY | $401.73 | — |
| LA | $415.96 | — |
| MA | $533.93 | — |
| MD | $401.73 | — |
| ME | $533.93 | — |
| MI | $504.86 | — |
| MN | $504.86 | — |
| MO | $401.73 | — |
| MS | $401.73 | — |
| MT | $505.28 | — |
| NC | $401.73 | — |
| ND | $505.28 | — |
| NE | $401.73 | — |
| NH | $533.93 | — |
| NJ | $429.77 | — |
| NM | $415.96 | — |
| NV | $418.92 | — |
| NY | $429.77 | — |
| OH | $504.86 | — |
| OK | $415.96 | — |
| OR | $514.91 | — |
| PA | $401.73 | — |
| PR | $761.40 | — |
| RI | $533.93 | — |
| SC | $401.73 | — |
| SD | $505.28 | — |
| TN | $401.73 | — |
| TX | $415.96 | — |
| UT | $505.28 | — |
| VA | $401.73 | — |
| VI | $429.77 | — |
| VT | $533.93 | — |
| WA | $514.91 | — |
| WI | $504.86 | — |
| WV | $401.73 | — |
| WY | $505.28 | — |
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
Bill L1920 with confidence
MyMedi-AI scrubs whole claims against NCCI pairs, MUE limits, modifier rules, and PA flags before you submit — built for DME teams, no PHI stored on our servers.
Start free trial Run a CMS-0057-F readiness checkPrefer DIY compliance? Self-audit documentation kits for DME suppliers →