MyMedi-AI

L8641 — Metatarsal joint implant

HCPCS Level II L-code

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.

L8641 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $428.55 to $571.40 depending on state and rural status.

Former-CBA payment limits: ceiling $571.40 · floor $428.55

StateNon-ruralRural
AL$447.67—
AR$428.55—
AZ$433.44—
CA$433.44—
CO$571.40—
CT$571.40—
DC$428.55—
DE$428.55—
FL$447.67—
GA$447.67—
IA$428.55—
ID$571.40—
IL$428.55—
IN$428.55—
KS$428.55—
KY$447.67—
LA$428.55—
MA$571.40—
MD$428.55—
ME$571.40—
MI$428.55—
MN$428.55—
MO$428.55—
MS$447.67—
MT$571.40—
NC$447.67—
ND$571.40—
NE$428.55—
NH$571.40—
NJ$428.55—
NM$428.55—
NV$433.44—
NY$428.55—
OH$428.55—
OK$428.55—
OR$571.40—
PA$428.55—
RI$571.40—
SC$447.67—
SD$571.40—
TN$447.67—
TX$428.55—
UT$571.40—
VA$428.55—
VT$571.40—
WA$571.40—
WI$428.55—
WV$428.55—
WY$571.40—
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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