MyMedi-AI

L1940 — Ankle foot orthosis, plastic or other material, custom fabricated

HCPCS Level II L-code · short descriptor: “Afo molded to patient plasti”

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 (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 2026-10-26; 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 REQUIRED L1940 is on Medicare's Required Face-to-Face & WOPD List (Orthoses — CMS Required F2F & WOPD List — 83 items in force on 2026-10-26; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). 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.

L1940 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $568.30 to $1522.87 depending on state and rural status.

Former-CBA payment limits: ceiling $757.73 · floor $568.30

StateNon-ruralRural
AK$795.23—
AL$614.33—
AR$581.88—
AZ$757.73—
CA$757.73—
CO$568.30—
CT$757.73—
DC$568.30—
DE$568.30—
FL$614.33—
GA$614.33—
HI$850.39—
IA$622.32—
ID$610.50—
IL$598.47—
IN$598.47—
KS$622.32—
KY$614.33—
LA$581.88—
MA$757.73—
MD$568.30—
ME$757.73—
MI$598.47—
MN$598.47—
MO$622.32—
MS$614.33—
MT$568.30—
NC$614.33—
ND$568.30—
NE$622.32—
NH$757.73—
NJ$721.37—
NM$581.88—
NV$757.73—
NY$721.37—
OH$598.47—
OK$581.88—
OR$610.50—
PA$568.30—
PR$1522.87—
RI$757.73—
SC$614.33—
SD$568.30—
TN$614.33—
TX$581.88—
UT$568.30—
VA$568.30—
VI$721.36—
VT$757.73—
WA$610.50—
WI$598.47—
WV$568.30—
WY$568.30—
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 L1940 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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