MyMedi-AI

L3927 — Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), without joint/spring, extension/flexion (e.g., static or ring type), may include soft interface material, prefabricated, off-the-shelf

HCPCS Level II L-code · short descriptor: “Fo pip dip no jt spr pre ots”

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.

L3927 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $38.15 to $42.00 depending on state and rural status.

Former-CBA payment limits: ceiling $46.60 · floor $34.95

StateNon-ruralRural
AK$38.17—
AL$39.34—
AR$39.34—
AZ$38.17—
CA$38.17—
CO$39.56—
CT$38.15—
DC$38.17—
DE$38.17—
FL$39.34—
GA$39.34—
HI$38.17—
IA$38.93—
ID$38.17—
IL$39.15—
IN$39.15—
KS$38.93—
KY$39.34—
LA$39.34—
MA$38.15—
MD$38.17—
ME$38.15—
MI$39.15—
MN$39.15—
MO$38.93—
MS$39.34—
MT$39.56—
NC$39.34—
ND$39.56—
NE$38.93—
NH$38.15—
NJ$38.15—
NM$39.34—
NV$38.17—
NY$38.15—
OH$39.15—
OK$39.34—
OR$38.17—
PA$38.17—
PR$42.00—
RI$38.15—
SC$39.34—
SD$39.56—
TN$39.34—
TX$39.34—
UT$39.56—
VA$38.17—
VI$42.00—
VT$38.15—
WA$38.17—
WI$39.15—
WV$38.17—
WY$39.56—
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 L3927 at 4 units per date of service (clinical). Units above the MUE deny — typically as CO-151. Rationale: Clinical: Data.

Common denial codes to watch

Related L-codes

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