MyMedi-AI

L2397 — Addition to lower extremity orthosis, suspension sleeve

HCPCS Level II L-code · short descriptor: “Suspension sleeve lower ext”

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
4
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.

L2397 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $134.68 to $165.97 depending on state and rural status.

Former-CBA payment limits: ceiling $172.19 · floor $129.14

StateNon-ruralRural
AK$144.60—
AL$134.68—
AR$134.68—
AZ$151.86—
CA$151.86—
CO$147.97—
CT$141.69—
DC$140.07—
DE$140.07—
FL$134.68—
GA$134.68—
HI$144.60—
IA$154.84—
ID$151.86—
IL$150.00—
IN$150.00—
KS$154.84—
KY$134.68—
LA$134.68—
MA$141.69—
MD$140.07—
ME$141.69—
MI$150.00—
MN$150.00—
MO$154.84—
MS$134.68—
MT$147.97—
NC$134.68—
ND$147.97—
NE$154.84—
NH$141.69—
NJ$135.65—
NM$134.68—
NV$151.86—
NY$135.65—
OH$150.00—
OK$134.68—
OR$151.86—
PA$140.07—
PR$165.97—
RI$141.69—
SC$134.68—
SD$147.97—
TN$134.68—
TX$134.68—
UT$147.97—
VA$140.07—
VI$135.65—
VT$141.69—
WA$151.86—
WI$150.00—
WV$140.07—
WY$147.97—
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 L2397 at 4 units per date of service (clinical). Units above the MUE deny — typically as CO-151. Rationale: Anatomic Consideration.

Common denial codes to watch

Related L-codes

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