L3961 — Shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
HCPCS Level II L-code · short descriptor: “Sewho cap design w/o jnts cf”
- 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
- 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.
L3961 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $1834.09 to $2017.52 depending on state and rural status.
Former-CBA payment limits: ceiling $2238.26 · floor $1678.69
| State | Non-rural | Rural |
|---|---|---|
| AK | $1834.09 | — |
| AL | $1889.33 | — |
| AR | $1889.14 | — |
| AZ | $1834.09 | — |
| CA | $1834.09 | — |
| CO | $1899.76 | — |
| CT | $1834.09 | — |
| DC | $1834.09 | — |
| DE | $1834.09 | — |
| FL | $1889.33 | — |
| GA | $1889.33 | — |
| HI | $1834.09 | — |
| IA | $1869.94 | — |
| ID | $1834.09 | — |
| IL | $1879.17 | — |
| IN | $1879.17 | — |
| KS | $1869.94 | — |
| KY | $1889.33 | — |
| LA | $1889.14 | — |
| MA | $1834.09 | — |
| MD | $1834.09 | — |
| ME | $1834.09 | — |
| MI | $1879.17 | — |
| MN | $1879.17 | — |
| MO | $1869.94 | — |
| MS | $1889.33 | — |
| MT | $1899.76 | — |
| NC | $1889.33 | — |
| ND | $1899.76 | — |
| NE | $1869.94 | — |
| NH | $1834.09 | — |
| NJ | $1834.09 | — |
| NM | $1889.14 | — |
| NV | $1834.09 | — |
| NY | $1834.09 | — |
| OH | $1879.17 | — |
| OK | $1889.14 | — |
| OR | $1834.09 | — |
| PA | $1834.09 | — |
| PR | $2017.52 | — |
| RI | $1834.09 | — |
| SC | $1889.33 | — |
| SD | $1899.76 | — |
| TN | $1889.33 | — |
| TX | $1889.14 | — |
| UT | $1899.76 | — |
| VA | $1834.09 | — |
| VI | $2017.52 | — |
| VT | $1834.09 | — |
| WA | $1834.09 | — |
| WI | $1879.17 | — |
| WV | $1834.09 | — |
| WY | $1899.76 | — |
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
Bill L3961 with confidence
MyMedi-AI scrubs whole claims against NCCI pairs, MUE limits, modifier rules, and PA flags before you submit — built for DME teams, no PHI stored on our servers.
Start free trial Run a CMS-0057-F readiness checkPrefer DIY compliance? Self-audit documentation kits for DME suppliers →