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L2387 — Addition to lower extremity, polycentric knee joint, for custom fabricated knee ankle foot orthosis, each joint

HCPCS Level II L-code · short descriptor: “Add le poly knee custom kafo”

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
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))

Not on the F2F/WOPD list (April 13, 2026 update — 83 items). The standard written order must reach the supplier before claim submission.

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

L2387 Medicare fee schedule (April 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $81.66 to $291.68 depending on state and rural status.

Former-CBA payment limits: ceiling $253.57 · floor $190.18

StateNon-ruralRural
AK$272.72
AL$208.88
AR$190.18
AZ$253.57
CA$253.57
CO$190.18
CT$253.57
DC$221.76
DE$221.76
FL$208.88
GA$208.88
HI$291.68
IA$190.18
ID$233.37
IL$234.60
IN$234.60
KS$190.18
KY$208.88
LA$190.18
MA$253.57
MD$221.76
ME$253.57
MI$234.60
MN$234.60
MO$190.18
MS$208.88
MT$190.18
NC$208.88
ND$190.18
NE$190.18
NH$253.57
NJ$190.18
NM$190.18
NV$253.57
NY$190.18
OH$234.60
OK$190.18
OR$233.37
PA$221.76
PR$81.66
RI$253.57
SC$208.88
SD$190.18
TN$208.88
TX$190.18
UT$190.18
VA$221.76
VI$190.18
VT$253.57
WA$233.37
WI$234.60
WV$221.76
WY$190.18
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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