`L2397` Suspension sleeve lower ext

Addition to lower extremity orthosis, suspension sleeve

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 4 units per day (clinical), rationale: Anatomic Consideration
DME supplier: max 4 units per day (clinical), rationale: Anatomic Consideration

Medicare pricing for L2397

DMEPOS fee schedule, July 2026 (DME26-C)

no modifier, prosthetics and orthotics (PO): non-rural $134.68 to $154.84 in the contiguous states; $135.65 to $165.97 in AK, HI, PR and VI; ceiling $172.19, floor $129.14

Payer policies and prior authorization for L2397

1 of 1 payer prior-auth lists that name L2397 require prior authorization or set conditions: Blue Shield of California Promise Health Plan.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Blue Shield of California Promise Health Plan	Promise Health Plan Medi-Cal	CA	prior auth required		Sep 1, 2026	Medi-Cal Prior Authorization List

Payer coverage policies that name L2397

L2397 appears in 6 coverage policies from Aetna, Anthem, Blue Shield of California, Cigna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Ankle Orthoses, Ankle-Foot Orthoses (AFOs), and Knee-Ankle-Foot Orthoses (KAFOs) (0565)	covered if criteria are met	Aug 26, 2026	payer document
Aetna	Knee Braces (1094)	covered if criteria are met	Jan 20, 2026	payer document
Aetna	Orthopedic Casts, Braces and Splints (0009)	listed, no stance (range L1600-L2999)	Jan 20, 2026	payer document
Anthem	Ankle-Foot and Knee-Ankle-Foot Orthoses (CG-OR-PR-13)	covered if criteria are met (range L2200-L2397)	Aug 13, 2026	payer document
Blue Shield of California	BSC1.05 \| Knee Braces (Custom)	listed, no stance		payer document
Cigna	Orthotic Devices and Shoes (0543)	covered if criteria are met	Sep 15, 2026	payer document

Medicaid fee-for-service

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

AZ: $127.23 (dme), effective Oct 1, 2026
CO: $101.55 (chp_plus, non-facility), effective Jul 1, 2026
FL: $70.11 (dme), effective Jul 1, 2026
IL: $113.92 (dme), effective Jan 1, 2026
IN: $125.00 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026
KS: $123.87 (default), effective Jul 1, 2026
KY: $84.16 (dme), effective Jan 1, 2026
LA: $73.10 (dme), effective Jul 1, 2012
MA: $108.41 (orthotics_prosthetics_rates), effective Apr 1, 2024
MD: $119.06 (dme), effective Apr 1, 2026
MS: $107.74 (comprehensive), effective Jul 1, 2026
ND: $0.00 (dme), effective Aug 1, 2026
NE: $132.93 (dme), effective Jul 1, 2026
NY: $24.24 (dme), effective Jul 1, 2026
OH: $77.99 (dme), effective Jan 1, 2010
OK: $94.28 (dme), effective Jan 1, 2026
TX: $99.23 (dmepos_tos_9_e_j_l_and_r, Hospital - Long Term, Limited, Or Specialized Ca, facility), effective Oct 1, 2018
VA: $126.06 (dme), effective Dec 1, 2026
VT: $118.77 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $114.14 (prosthetics_orthotics), effective Jul 1, 2026
WY: $91.12 (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.

L2397 Suspension sleeve lower ext