MyMedi-AI

L1960 — Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated

HCPCS Level II L-code · short descriptor: “Afo pos solid ank plastic mo”

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 2026-10-25; 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 REQUIRED L1960 is on Medicare's Required Face-to-Face & WOPD List (Orthoses — 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)). 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.

L1960 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $636.95 to $1522.87 depending on state and rural status.

Former-CBA payment limits: ceiling $849.26 · floor $636.95

StateNon-ruralRural
AK$911.79—
AL$636.95—
AR$636.95—
AZ$849.26—
CA$849.26—
CO$636.95—
CT$849.26—
DC$679.46—
DE$679.46—
FL$636.95—
GA$636.95—
HI$975.00—
IA$636.95—
ID$636.95—
IL$761.80—
IN$761.80—
KS$636.95—
KY$636.95—
LA$636.95—
MA$849.26—
MD$679.46—
ME$849.26—
MI$761.80—
MN$761.80—
MO$636.95—
MS$636.95—
MT$636.95—
NC$636.95—
ND$636.95—
NE$636.95—
NH$849.26—
NJ$849.26—
NM$636.95—
NV$849.26—
NY$849.26—
OH$761.80—
OK$636.95—
OR$636.95—
PA$679.46—
PR$1522.87—
RI$849.26—
SC$636.95—
SD$636.95—
TN$636.95—
TX$636.95—
UT$636.95—
VA$679.46—
VI$849.26—
VT$849.26—
WA$636.95—
WI$761.80—
WV$679.46—
WY$636.95—
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 L1960 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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