Lift, elevation, heel, tapered to metatarsals, per inch
Medicare coverage: Special coverage instructions apply
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: Clinical: CMS Workgroup
DME supplier: max 4 units per day (clinical), rationale: Clinical: Data
Medicare pricing for L3300
DMEPOS fee schedule, July 2026 (DME26-C)
no modifier, prosthetics and orthotics (PO): non-rural $62.55 to $64.79 in the contiguous states; $62.55 to $68.81 in AK, HI, PR and VI; ceiling $76.33, floor $57.25
Payer policies and prior authorization for L3300
1 of 1 payer prior-auth lists that name L3300 require prior authorization or set conditions: Rocky Mountain Health Plans.
TX: $31.58 (dmepos_tos_9_e_j_l_and_r, Medical Supplier (Dme), non-facility), effective Mar 1, 2026
VA: $56.30 (dme), effective Dec 1, 2026
VT: $52.43 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $39.89 (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.