Shoulder elbow wrist hand orthosis, abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, 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 1 units per day (clinical), rationale: Nature of Equipment
DME supplier: max 1 units per day (clinical), rationale: Nature of Equipment
Medicare pricing for L3973
DMEPOS fee schedule, July 2026 (DME26-C)
no modifier, prosthetics and orthotics (PO): non-rural $2,165.46 to $2,242.98 in the contiguous states; $2,165.46 to $2,382.03 in AK, HI, PR and VI; ceiling $2,642.64, floor $1,981.98
Payer policies and prior authorization for L3973
15 of 15 payer prior-auth lists that name L3973 require prior authorization or set conditions: CarePlus Health Plans, Humana, Medicare, UnitedHealthcare.
Payer
Plan
State
Prior auth
Conditions
Since
Source
Medicare
DMEPOS Master List (items potentially subject to PA)
All
prior auth under conditions
On the Master List; PA only if CMS selects it for the Required List
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.