MyMedi-AI

L8630 — Metacarpophalangeal joint implant

HCPCS Level II L-code · short descriptor: “Metacarpophalangeal implant”

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
Face-to-face & WOPD
Not on the required list
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.

L8630 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $412.46 to $549.94 depending on state and rural status.

Former-CBA payment limits: ceiling $549.94 · floor $412.46

StateNon-ruralRural
AL$412.46—
AR$412.46—
AZ$412.46—
CA$412.46—
CO$542.20—
CT$549.94—
DC$412.46—
DE$412.46—
FL$412.46—
GA$412.46—
IA$412.46—
ID$412.46—
IL$549.94—
IN$549.94—
KS$412.46—
KY$412.46—
LA$412.46—
MA$549.94—
MD$412.46—
ME$549.94—
MI$549.94—
MN$549.94—
MO$412.46—
MS$412.46—
MT$542.20—
NC$412.46—
ND$542.20—
NE$412.46—
NH$549.94—
NJ$412.46—
NM$412.46—
NV$412.46—
NY$412.46—
OH$549.94—
OK$412.46—
OR$412.46—
PA$412.46—
RI$549.94—
SC$412.46—
SD$542.20—
TN$412.46—
TX$412.46—
UT$542.20—
VA$412.46—
VT$549.94—
WA$412.46—
WI$549.94—
WV$412.46—
WY$542.20—
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.

Common denial codes to watch

Related L-codes

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