Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
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 2 units per day (policy), rationale: Anatomic Consideration
DME supplier: max 2 units per day (policy), rationale: Anatomic Consideration
Medicare pricing for L4396
DMEPOS fee schedule, July 2026 (DME26-C)
no modifier, prosthetics and orthotics (PO): non-rural $197.90 to $210.28 in the contiguous states; $197.90 to $241.56 in AK, HI, PR and VI; ceiling $245.21, floor $183.91
Payer policies and prior authorization for L4396
1 of 1 payer prior-auth lists that name L4396 require prior authorization or set conditions: Medicare.
Payer
Plan
State
Prior auth
Conditions
Since
Source
Medicare
DMEPOS Probationary Prior Authorization (new suppliers)
All
prior auth under conditions
Newly enrolled or changed-ownership suppliers in their probationary year
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.