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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)
Status
Active (April 2026 HCPCS)

Prior authorization

Not on the Medicare required-PA list as of the January 13, 2026 update (74 items). 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 — list effective 2026-04-13, 83 items). 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 (April 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 April 2026. 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.

Common denial codes to watch

Related L-codes

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