MyMedi-AI

L8659 — Interphalangeal finger joint replacement, 2 or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon) for surgical implantation, any size

HCPCS Level II L-code · short descriptor: “Interphalangeal joint repl”

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 2026-10-26; 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 2026-10-26; 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.

L8659 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $2319.17 to $2407.00 depending on state and rural status.

Former-CBA payment limits: ceiling $2830.92 · floor $2123.19

StateNon-ruralRural
AL$2388.97—
AR$2388.80—
AZ$2319.17—
CA$2319.17—
CO$2407.00—
CT$2319.17—
DC$2319.17—
DE$2319.17—
FL$2388.97—
GA$2388.97—
IA$2364.47—
ID$2319.17—
IL$2376.14—
IN$2376.14—
KS$2364.47—
KY$2388.97—
LA$2388.80—
MA$2319.17—
MD$2319.17—
ME$2319.17—
MI$2376.14—
MN$2376.14—
MO$2364.47—
MS$2388.97—
MT$2407.00—
NC$2388.97—
ND$2407.00—
NE$2364.47—
NH$2319.17—
NJ$2319.17—
NM$2388.80—
NV$2319.17—
NY$2319.17—
OH$2376.14—
OK$2388.80—
OR$2319.17—
PA$2319.17—
RI$2319.17—
SC$2388.97—
SD$2407.00—
TN$2388.97—
TX$2388.80—
UT$2407.00—
VA$2319.17—
VT$2319.17—
WA$2319.17—
WI$2376.14—
WV$2319.17—
WY$2407.00—
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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