L1971 Ankl foot ortho, customi fit

Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Medically Unlikely Edits (effective October 1, 2026)

Medicare pricing for L1971

DMEPOS fee schedule, July 2026 (DME26-C)

Payer policies and prior authorization for L1971

1 of 1 payer prior-auth lists that name L1971 require prior authorization or set conditions: Medicare.

PayerPlanStatePrior authConditionsSinceSource
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 L1971

L1971 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

  • Jul 1, 2026: PA removed, HealthSpring
  • Jul 1, 2024: PA removed, Blue Shield of California Promise Health Plan

Medicaid fee-for-service

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

  • AZ: $523.38 (dme), effective Oct 1, 2026
  • CO: $443.61 (chp_plus, non-facility), effective Jul 1, 2026
  • IL: $437.50 (dme), effective Jan 1, 2026
  • IN: $480.08 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026
  • KS: $458.57 (default), effective Jul 1, 2026
  • KY: $303.52 (dme), effective Jan 1, 2026
  • LA: $314.38 (dme), effective Jul 1, 2012
  • MA: $430.21 (orthotics_prosthetics_rates), effective Apr 1, 2024
  • MD: $477.90 (dme), effective Apr 1, 2026
  • MS: $463.34 (comprehensive), effective Jul 1, 2026
  • ND: $672.34 (dme), effective Aug 1, 2026
  • NE: $492.17 (dme), effective Jul 1, 2026
  • NY: $334.78 (dme), effective Jul 1, 2026
  • OH: $360.00 (dme), effective Jul 16, 2018
  • OK: $405.38 (dme), effective Jan 1, 2026
  • TX: $379.96 (dmepos_tos_9_e_j_l_and_r, Medical Supplier (Dme), non-facility), effective May 1, 2005
  • VA: $506.01 (dme), effective Dec 1, 2026
  • VT: $471.28 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $422.56 (prosthetics_orthotics), effective Jul 1, 2026
  • WY: $358.58 (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.