L1906 Afo multilig ank sup pre ots

Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf

Medically Unlikely Edits (effective October 1, 2026)

Medicare pricing for L1906

DMEPOS fee schedule, July 2026 (DME26-C)

Payer policies and prior authorization for L1906

2 of 2 payer prior-auth lists that name L1906 require prior authorization or set conditions: Medicare.

PayerPlanStatePrior authConditionsSinceSource
MedicareDMEPOS Master List (items potentially subject to PA)Allprior auth under conditionsOn the Master List; PA only if CMS selects it for the Required ListJul 30, 2026Master List of DMEPOS Items Potentially Subject to Face-to-Face Encounter and Written Order Prior to Delivery and/or Prior Authorization Requirements
MedicareDMEPOS Probationary Prior Authorization (new suppliers)Allprior auth under conditionsNewly enrolled or changed-ownership suppliers in their probationary yearOct 15, 2026DMEPOS Probationary Prior Authorization List

Payer coverage policies that name L1906

L1906 appears in 5 coverage policies from Aetna, Anthem, Cigna.

PayerPolicyRole in policyReviewedDocument
AetnaAnkle Orthoses, Ankle-Foot Orthoses (AFOs), and Knee-Ankle-Foot Orthoses (KAFOs) (0565)covered if criteria are metAug 26, 2026payer document
AetnaOrthopedic Casts, Braces and Splints (0009)listed, no stance (range L1900-L1990)Jan 20, 2026payer document
AetnaOrthopedic Casts, Braces and Splints (0009)listed, no stance (range L1600-L2999)Jan 20, 2026payer document
AetnaPedobarography (0294)listed, no stance (range L1900-L1990)Apr 17, 2026payer document
AnthemAnkle-Foot and Knee-Ankle-Foot Orthoses (CG-OR-PR-13)
Orthoses
covered if criteria are met (range L1900-L1990)Aug 13, 2026payer document
CignaOrthotic Devices and Shoes (0543)covered if criteria are metSep 15, 2026payer document

Recent prior-auth changes

  • Nov 1, 2025: PA removed, Blue Shield of California Promise Health Plan

Medicaid fee-for-service

Prior authorization required or conditional in LA, MA, MS, NY, VA.

  • AZ: $171.53 (dme), effective Oct 1, 2026
  • CO: $126.45 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $90.04 (dme, OS), effective Jul 1, 2026
  • IL: $78.19 (dme), effective Jan 1, 2026
  • IN: $115.17 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026
  • KS: $110.56 (default), effective Jul 1, 2026
  • KY: $98.67 (dme), effective Jan 1, 2026
  • LA: $75.02 (dme), effective Jul 1, 2012
  • MA: $118.42 (orthotics_prosthetics_rates), effective Apr 1, 2024
  • MD: $117.47 (dme), effective Apr 1, 2026
  • MS: $126.34 (comprehensive), effective Jul 1, 2026
  • ND: $193.26 (dme), effective Aug 1, 2026
  • NE: $118.65 (dme), effective Jul 1, 2026
  • NY: $75.75 (dme), effective Jul 1, 2026
  • OH: $71.85 (dme), effective Jan 1, 2010
  • OK: $96.74 (dme), effective Jan 1, 2026
  • TX: $75.16 (dmepos_tos_9_e_j_l_and_r, Hospital - Long Term, Limited, Or Specialized Ca, facility), effective Apr 1, 1992
  • VA: $124.38 (dme), effective Dec 1, 2026
  • VT: $129.72 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $133.36 (prosthetics_orthotics), effective Jul 1, 2026
  • WY: $113.45 (professional), effective Jan 1, 2021

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.