MyMedi-AI

L2036 — Knee ankle foot orthosis, full plastic, double upright, with or without free motion knee, with or without free motion ankle, custom fabricated

HCPCS Level II L-code · short descriptor: “Kafo plas doub free knee mol”

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 2026-10-26; 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 L2036 is on Medicare's Required Face-to-Face & WOPD List (Orthoses — CMS Required F2F & WOPD List — 83 items in force on 2026-10-26; 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.

L2036 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $2131.99 to $4092.63 depending on state and rural status.

Former-CBA payment limits: ceiling $2842.66 · floor $2131.99

StateNon-ruralRural
AK$2590.22—
AL$2131.99—
AR$2240.26—
AZ$2549.08—
CA$2549.08—
CO$2340.32—
CT$2842.66—
DC$2209.36—
DE$2209.36—
FL$2131.99—
GA$2131.99—
HI$2769.78—
IA$2131.99—
ID$2750.39—
IL$2278.43—
IN$2278.43—
KS$2131.99—
KY$2131.99—
LA$2240.26—
MA$2842.66—
MD$2209.36—
ME$2842.66—
MI$2278.43—
MN$2278.43—
MO$2131.99—
MS$2131.99—
MT$2340.32—
NC$2131.99—
ND$2340.32—
NE$2131.99—
NH$2842.66—
NJ$2842.66—
NM$2240.26—
NV$2549.08—
NY$2842.66—
OH$2278.43—
OK$2240.26—
OR$2750.39—
PA$2209.36—
PR$4092.63—
RI$2842.66—
SC$2131.99—
SD$2340.32—
TN$2131.99—
TX$2240.26—
UT$2340.32—
VA$2209.36—
VI$2842.66—
VT$2842.66—
WA$2750.39—
WI$2278.43—
WV$2209.36—
WY$2340.32—
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 L2036 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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