L3214 Benesch boot pair junior

Benesch boot, pair, junior

Medically Unlikely Edits (effective October 1, 2026)

Payer policies and prior authorization for L3214

1 of 1 payer prior-auth lists that name L3214 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue).

PayerPlanStatePrior authConditionsSinceSource
Blue Cross Blue Shield of Arizona (AZ Blue)State of Arizona employee group (SYD, S3Z)AZprior auth requiredSep 1, 2026State of Arizona Group Prior Authorization Requirements Code List (09/01/2026)

Payer coverage policies that name L3214

L3214 appears in 5 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaAnkle Orthoses, Ankle-Foot Orthoses (AFOs), and Knee-Ankle-Foot Orthoses (KAFOs) (0565)covered if criteria are metAug 26, 2026payer document
AetnaBunionectomy (0629)listed, no stance (range L3201-L3265)Sep 11, 2026payer document
AetnaFoot Orthotics (0451)covered if criteria are met (range L3201-L3265)Jul 16, 2026payer document
AetnaPedobarography (0294)listed, no stance (range L3000-L3649)Apr 17, 2026payer document
AetnaPlantar Fasciitis Treatments (0235)listed, no stance (range L3000-L3265)Apr 27, 2026payer document

Recent prior-auth changes

  • Feb 1, 2024: PA removed, Blue Shield of California Promise Health Plan

Medicaid fee-for-service

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

  • CO: $112.29 (chp_plus, non-facility), effective Jul 1, 2026
  • IL: $73.17 (dme), effective Jan 1, 2026
  • KS: $50.00 (default), effective Apr 1, 2006
  • KY: $67.08 (dme), effective Jan 1, 2026
  • LA: $88.29 (dme), effective Jul 1, 2012
  • MS: $68.00 (comprehensive), effective Jul 1, 2026
  • ND: $87.90 (dme), effective Aug 1, 2026
  • NE: $71.56 (dme), effective Jul 1, 2026
  • NY: $22.22 (dme), effective Jul 1, 2026
  • TX: $15.64 (dmepos_tos_9_e_j_l_and_r, Hospital - Long Term, Limited, Or Specialized Ca, facility), effective Mar 1, 2021
  • VA: $71.38 (dme), effective Dec 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026

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.