MyMedi-AI

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
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.

L8631 Medicare fee schedule (October 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

StateNon-ruralRural
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 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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