L3978 Sewhfo airplane w/jnt(s) cf

Shoulder elbow wrist hand finger 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

Medically Unlikely Edits (effective October 1, 2026)

Medicare pricing for L3978

DMEPOS fee schedule, July 2026 (DME26-C)

Payer policies and prior authorization for L3978

5 of 5 payer prior-auth lists that name L3978 require prior authorization or set conditions: Humana, Medicare, UnitedHealthcare.

PayerPlanStatePrior authConditionsSinceSource
MedicareDMEPOS Master List (items potentially subject to PA)Allprior auth under conditionsOn the Master List; PA only if CMS selects it for the Required ListJul 30, 2026Master List of DMEPOS Items Potentially Subject to Face-to-Face Encounter and Written Order Prior to Delivery and/or Prior Authorization Requirements
HumanaHumana Healthy HorizonsVAprior auth requiredJan 1, 2027Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL)
HumanaOak Street HealthAllprior auth requiredOak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management
UnitedHealthcareUnitedHealthcare Complete (Individual & Family plans)Allprior auth requiredSep 1, 2026Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026
UnitedHealthcareUnitedHealthcare Individual Exchange plansAllprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026

Payer coverage policies that name L3978

L3978 appears in 2 coverage policies from Aetna, Cigna.

PayerPolicyRole in policyReviewedDocument
AetnaOrthopedic Casts, Braces and Splints (0009)listed, no stance (range L3650-L4398)Jan 20, 2026payer document
CignaOrthotic Devices and Shoes (0543)covered if criteria are metSep 15, 2026payer document

Recent prior-auth changes

  • Jan 1, 2027: PA added, Humana
  • May 1, 2026: conditions changed, UnitedHealthcare
  • Apr 1, 2026: conditions changed, UnitedHealthcare
  • Apr 1, 2026: PA removed, UnitedHealthcare Community Plan
  • Jul 1, 2025: PA removed, Humana

Medicaid fee-for-service

Prior authorization required or conditional in CO, MA, MD, MS, NE, NY, OH, VA, WA, WV, WY.

  • AZ: $2015.83 (dme), effective Oct 1, 2026
  • CO: $1731.18 (chp_plus, non-facility), effective Jul 1, 2026
  • IN: $1848.86 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026
  • KS: $1766.19 (default), effective Jul 1, 2026
  • MA: $1899.46 (orthotics_prosthetics_rates), effective Apr 1, 2024
  • MD: $1840.64 (dme), effective Apr 1, 2026
  • MS: $1784.53 (comprehensive), effective Jul 1, 2026
  • NE: $1895.64 (dme), effective Jul 1, 2026
  • NY: $1534.67 (dme), effective Jul 1, 2026
  • OH: $1698.40 (dme), effective Jan 1, 2026
  • OK: $1561.36 (dme), effective Jan 1, 2026
  • TX: $1093.39 (dmepos_tos_9_e_j_l_and_r, Hospital - Long Term, Limited, Or Specialized Ca, facility), effective Mar 1, 2026
  • VA: $1948.91 (dme), effective Dec 1, 2026
  • VT: $1815.17 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $1627.50 (prosthetics_orthotics), effective Jul 1, 2026
  • WY: $1381.07 (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.