L1951 — Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
HCPCS Level II L-code · short descriptor: “Afo spiral prefab custom” · PA required
- 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
- Required (Medicare, since 2024-08-12)
- Status
- Active (April 2026 HCPCS)
Prior authorization
PA REQUIRED L1951 is on Medicare's DMEPOS Required Prior Authorization List (Orthoses — nationwide since 2024-08-12).
Claims for this item without an affirmed prior-authorization decision are automatically denied (commonly surfacing as CO-197). Submit the PA request to your DME MAC with the order and supporting clinical documentation before delivery.
L1951 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $1007.37 to $1108.09 depending on state and rural status.
Former-CBA payment limits: ceiling $1229.35 · floor $922.01
| State | Non-rural | Rural |
|---|---|---|
| AK | $1007.37 | — |
| AL | $1037.71 | — |
| AR | $1037.61 | — |
| AZ | $1007.37 | — |
| CA | $1007.37 | — |
| CO | $1043.45 | — |
| CT | $1007.37 | — |
| DC | $1007.37 | — |
| DE | $1007.37 | — |
| FL | $1037.71 | — |
| GA | $1037.71 | — |
| HI | $1007.37 | — |
| IA | $1027.04 | — |
| ID | $1007.37 | — |
| IL | $1032.09 | — |
| IN | $1032.09 | — |
| KS | $1027.04 | — |
| KY | $1037.71 | — |
| LA | $1037.61 | — |
| MA | $1007.37 | — |
| MD | $1007.37 | — |
| ME | $1007.37 | — |
| MI | $1032.09 | — |
| MN | $1032.09 | — |
| MO | $1027.04 | — |
| MS | $1037.71 | — |
| MT | $1043.45 | — |
| NC | $1037.71 | — |
| ND | $1043.45 | — |
| NE | $1027.04 | — |
| NH | $1007.37 | — |
| NJ | $1007.37 | — |
| NM | $1037.61 | — |
| NV | $1007.37 | — |
| NY | $1007.37 | — |
| OH | $1032.09 | — |
| OK | $1037.61 | — |
| OR | $1007.37 | — |
| PA | $1007.37 | — |
| PR | $1108.09 | — |
| RI | $1007.37 | — |
| SC | $1037.71 | — |
| SD | $1043.45 | — |
| TN | $1037.71 | — |
| TX | $1037.61 | — |
| UT | $1043.45 | — |
| VA | $1007.37 | — |
| VI | $1108.09 | — |
| VT | $1007.37 | — |
| WA | $1007.37 | — |
| WI | $1032.09 | — |
| WV | $1007.37 | — |
| WY | $1043.45 | — |
Common denial codes to watch
Related L-codes
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