Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf
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: Code Descriptor / CPT Instruction
DME supplier: max 4 units per day (clinical), rationale: Code Descriptor / CPT Instruction
Medicare pricing for L3925
DMEPOS fee schedule, July 2026 (DME26-C)
no modifier, prosthetics and orthotics (PO): non-rural $55.50 to $73.47 in the contiguous states; $45.08 to $75.84 in AK, HI, PR and VI; ceiling $74.01, floor $55.50
Payer policies and prior authorization for L3925
1 of 1 payer prior-auth lists that name L3925 require prior authorization or set conditions: Humana.
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.