L8631 — Metacarpal phalangeal joint replacement, two or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon), for surgical implantation (all sizes, includes entire system)
HCPCS Level II L-code · short descriptor: “Mcp joint repl 2 pc or more”
- 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.
L8631 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $2609.08 to $2768.01 depending on state and rural status.
Former-CBA payment limits: ceiling $3227.61 · floor $2420.71
| State | Non-rural | Rural |
|---|---|---|
| AL | $2768.01 | — |
| AR | $2687.37 | — |
| AZ | $2739.60 | — |
| CA | $2739.60 | — |
| CO | $2702.46 | — |
| CT | $2681.80 | — |
| DC | $2609.08 | — |
| DE | $2609.08 | — |
| FL | $2768.01 | — |
| GA | $2768.01 | — |
| IA | $2660.02 | — |
| ID | $2609.08 | — |
| IL | $2708.74 | — |
| IN | $2708.74 | — |
| KS | $2660.02 | — |
| KY | $2768.01 | — |
| LA | $2687.37 | — |
| MA | $2681.80 | — |
| MD | $2609.08 | — |
| ME | $2681.80 | — |
| MI | $2708.74 | — |
| MN | $2708.74 | — |
| MO | $2660.02 | — |
| MS | $2768.01 | — |
| MT | $2702.46 | — |
| NC | $2768.01 | — |
| ND | $2702.46 | — |
| NE | $2660.02 | — |
| NH | $2681.80 | — |
| NJ | $2657.22 | — |
| NM | $2687.37 | — |
| NV | $2739.60 | — |
| NY | $2657.22 | — |
| OH | $2708.74 | — |
| OK | $2687.37 | — |
| OR | $2609.08 | — |
| PA | $2609.08 | — |
| RI | $2681.80 | — |
| SC | $2768.01 | — |
| SD | $2702.46 | — |
| TN | $2768.01 | — |
| TX | $2687.37 | — |
| UT | $2702.46 | — |
| VA | $2609.08 | — |
| VT | $2681.80 | — |
| WA | $2609.08 | — |
| WI | $2708.74 | — |
| WV | $2609.08 | — |
| WY | $2702.46 | — |
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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