L3430 — Heel, counter, plastic reinforced
HCPCS Level II L-code · short descriptor: “Sho heel count plast reinfor”
- Code system
- HCPCS Level II
- Family
- L — Orthotics & prosthetics
- Medicare coverage status
- Special coverage instructions apply
- DMEPOS payment category
- Prosthetics & orthotics
- Prior authorization
- Not on Medicare required-PA 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.
L3430 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $192.22 to $211.48 depending on state and rural status.
Former-CBA payment limits: ceiling $234.58 · floor $175.93
| State | Non-rural | Rural |
|---|---|---|
| AK | $192.22 | — |
| AL | $198.00 | — |
| AR | $197.99 | — |
| AZ | $192.22 | — |
| CA | $192.22 | — |
| CO | $199.11 | — |
| CT | $192.22 | — |
| DC | $192.22 | — |
| DE | $192.22 | — |
| FL | $198.00 | — |
| GA | $198.00 | — |
| HI | $192.22 | — |
| IA | $195.99 | — |
| ID | $192.22 | — |
| IL | $196.94 | — |
| IN | $196.94 | — |
| KS | $195.99 | — |
| KY | $198.00 | — |
| LA | $197.99 | — |
| MA | $192.22 | — |
| MD | $192.22 | — |
| ME | $192.22 | — |
| MI | $196.94 | — |
| MN | $196.94 | — |
| MO | $195.99 | — |
| MS | $198.00 | — |
| MT | $199.11 | — |
| NC | $198.00 | — |
| ND | $199.11 | — |
| NE | $195.99 | — |
| NH | $192.22 | — |
| NJ | $192.22 | — |
| NM | $197.99 | — |
| NV | $192.22 | — |
| NY | $192.22 | — |
| OH | $196.94 | — |
| OK | $197.99 | — |
| OR | $192.22 | — |
| PA | $192.22 | — |
| PR | $211.48 | — |
| RI | $192.22 | — |
| SC | $198.00 | — |
| SD | $199.11 | — |
| TN | $198.00 | — |
| TX | $197.99 | — |
| UT | $199.11 | — |
| VA | $192.22 | — |
| VI | $211.48 | — |
| VT | $192.22 | — |
| WA | $192.22 | — |
| WI | $196.94 | — |
| WV | $192.22 | — |
| WY | $199.11 | — |
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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