Kafo, fracture orthosis, femoral fracture cast orthosis, semi-rigid, prefabricated, includes fitting and adjustment
Medicare coverage: Carrier judgment
Status: active (October 2026 file)
Medically Unlikely Edits (effective October 1, 2026)
Practitioner: max 0 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 2 units per day (policy), rationale: Anatomic Consideration
DME supplier: max 2 units per day (policy), rationale: Anatomic Consideration
Medicare pricing for L2134
DMEPOS fee schedule, July 2026 (DME26-C)
no modifier, prosthetics and orthotics (PO): non-rural $1,111.41 to $1,481.88 in the contiguous states; $1,481.88 to $1,713.20 in AK, HI, PR and VI; ceiling $1,481.88, floor $1,111.41
Payer policies and prior authorization for L2134
7 of 7 payer prior-auth lists that name L2134 require prior authorization or set conditions: Blue Shield of California Promise Health Plan, Humana, Medicare.
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.