L4396 — Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
HCPCS Level II L-code · short descriptor: “Static or dynami afo pre cst”
- 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.
L4396 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $197.90 to $241.56 depending on state and rural status.
Former-CBA payment limits: ceiling $245.21 · floor $183.91
| State | Non-rural | Rural |
|---|---|---|
| AK | $197.90 | — |
| AL | $207.41 | — |
| AR | $207.40 | — |
| AZ | $197.90 | — |
| CA | $197.90 | — |
| CO | $204.74 | — |
| CT | $210.28 | — |
| DC | $201.26 | — |
| DE | $201.26 | — |
| FL | $207.41 | — |
| GA | $207.41 | — |
| HI | $197.90 | — |
| IA | $197.90 | — |
| ID | $197.90 | — |
| IL | $206.23 | — |
| IN | $206.23 | — |
| KS | $197.90 | — |
| KY | $207.41 | — |
| LA | $207.40 | — |
| MA | $210.28 | — |
| MD | $201.26 | — |
| ME | $210.28 | — |
| MI | $206.23 | — |
| MN | $206.23 | — |
| MO | $197.90 | — |
| MS | $207.41 | — |
| MT | $204.74 | — |
| NC | $207.41 | — |
| ND | $204.74 | — |
| NE | $197.90 | — |
| NH | $210.28 | — |
| NJ | $201.26 | — |
| NM | $207.40 | — |
| NV | $197.90 | — |
| NY | $201.26 | — |
| OH | $206.23 | — |
| OK | $207.40 | — |
| OR | $197.90 | — |
| PA | $201.26 | — |
| PR | $241.56 | — |
| RI | $210.28 | — |
| SC | $207.41 | — |
| SD | $204.74 | — |
| TN | $207.41 | — |
| TX | $207.40 | — |
| UT | $204.74 | — |
| VA | $201.26 | — |
| VI | $201.26 | — |
| VT | $210.28 | — |
| WA | $197.90 | — |
| WI | $206.23 | — |
| WV | $201.26 | — |
| WY | $204.74 | — |
Common denial codes to watch
Related L-codes
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