Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, 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 2 units per day (policy), rationale: Anatomic Consideration
DME supplier: max 2 units per day (policy), rationale: Anatomic Consideration
Medicare pricing for L4397
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 L4397
1 of 1 payer prior-auth lists that name L4397 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.