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L2005 — Knee ankle foot orthosis, any material, single or double upright, stance control, automatic lock and swing phase release, any type activation, includes ankle joint, any type, custom fabricated

HCPCS Level II L-code · short descriptor: “Kafo sng/dbl mechanical act”

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 L2005 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.

L2005 Medicare fee schedule (April 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $4915.21 to $5406.75 depending on state and rural status.

Former-CBA payment limits: ceiling $5999.81 · floor $4499.86

StateNon-ruralRural
AK$4915.21
AL$5063.24
AR$5062.71
AZ$4915.21
CA$4915.21
CO$5101.37
CT$4915.21
DC$4915.21
DE$4915.21
FL$5063.24
GA$5063.24
HI$4915.21
IA$5011.19
ID$4915.21
IL$5035.93
IN$5035.93
KS$5011.19
KY$5063.24
LA$5062.71
MA$4915.21
MD$4915.21
ME$4915.21
MI$5035.93
MN$5035.93
MO$5011.19
MS$5063.24
MT$5101.37
NC$5063.24
ND$5101.37
NE$5011.19
NH$4915.21
NJ$4915.21
NM$5062.71
NV$4915.21
NY$4915.21
OH$5035.93
OK$5062.71
OR$4915.21
PA$4915.21
PR$5406.75
RI$4915.21
SC$5063.24
SD$5101.37
TN$5063.24
TX$5062.71
UT$5101.37
VA$4915.21
VI$5406.75
VT$4915.21
WA$4915.21
WI$5035.93
WV$4915.21
WY$5101.37
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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