MyMedi-AI

L1970 — Ankle foot orthosis, plastic with ankle joint, custom fabricated

HCPCS Level II L-code · short descriptor: “Afo plastic molded w/ankle j”

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 L1970 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.

L1970 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $817.68 to $1289.75 depending on state and rural status.

Former-CBA payment limits: ceiling $1090.24 · floor $817.68

StateNon-ruralRural
AK$860.68—
AL$942.10—
AR$817.68—
AZ$888.03—
CA$888.03—
CO$859.02—
CT$1090.24—
DC$817.68—
DE$817.68—
FL$942.10—
GA$942.10—
HI$920.33—
IA$977.34—
ID$850.01—
IL$850.61—
IN$850.61—
KS$977.34—
KY$942.10—
LA$817.68—
MA$1090.24—
MD$817.68—
ME$1090.24—
MI$850.61—
MN$850.61—
MO$977.34—
MS$942.10—
MT$859.02—
NC$942.10—
ND$859.02—
NE$977.34—
NH$1090.24—
NJ$1084.52—
NM$817.68—
NV$888.03—
NY$1084.52—
OH$850.61—
OK$817.68—
OR$850.01—
PA$817.68—
PR$1289.75—
RI$1090.24—
SC$942.10—
SD$859.02—
TN$942.10—
TX$817.68—
UT$859.02—
VA$817.68—
VI$1084.53—
VT$1090.24—
WA$850.01—
WI$850.61—
WV$817.68—
WY$859.02—
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 L1970 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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