MyMedi-AI

L2180 — Addition to lower extremity fracture orthosis, plastic shoe insert with ankle joints

HCPCS Level II L-code · short descriptor: “Plas shoe insert w ank joint”

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
Not on the required list
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))

Not on the F2F/WOPD list (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)). The standard written order must reach the supplier before claim submission.

Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.

L2180 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $95.20 to $220.62 depending on state and rural status.

Former-CBA payment limits: ceiling $179.43 · floor $134.58

StateNon-ruralRural
AK$206.30—
AL$134.58—
AR$179.43—
AZ$179.43—
CA$179.43—
CO$175.25—
CT$158.74—
DC$137.83—
DE$137.83—
FL$134.58—
GA$134.58—
HI$220.62—
IA$135.62—
ID$134.58—
IL$162.92—
IN$162.92—
KS$135.62—
KY$134.58—
LA$179.43—
MA$158.74—
MD$137.83—
ME$158.74—
MI$162.92—
MN$162.92—
MO$135.62—
MS$134.58—
MT$175.25—
NC$134.58—
ND$175.25—
NE$135.62—
NH$158.74—
NJ$134.58—
NM$179.43—
NV$179.43—
NY$134.58—
OH$162.92—
OK$179.43—
OR$134.58—
PA$137.83—
PR$95.20—
RI$158.74—
SC$134.58—
SD$175.25—
TN$134.58—
TX$179.43—
UT$175.25—
VA$137.83—
VI$134.58—
VT$158.74—
WA$134.58—
WI$162.92—
WV$137.83—
WY$175.25—
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 L2180 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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