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L1952 — Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, off-the-shelf

HCPCS Level II L-code · short descriptor: “Afo spiral prefab 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 L1952 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.

L1952 Medicare fee schedule (October 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

StateNon-ruralRural
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—
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 L1952 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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