HCPCS Level II › L codes L8641 Metatarsal joint implantMetatarsal joint implant
Medicare coverage: Special coverage instructions apply Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 4 units per day (clinical), rationale: Clinical: Data Outpatient hospital: max 4 units per day (clinical), rationale: Clinical: Data DME supplier: max 0 units per day (clinical), rationale: CMS Policy Medicare pricing for L8641 DMEPOS fee schedule, July 2026 (DME26-C) no modifier, prosthetics and orthotics (PO): non-rural $428.55 to $571.40 in the contiguous states; ceiling $571.40, floor $428.55 Payer policies and prior authorization for L8641 19 of 19 payer prior-auth lists that name L8641 require prior authorization or set conditions: CarePlus Health Plans, Cigna, Humana.
Payer Plan State Prior auth Conditions Since Source Cigna ACA/IFP All prior auth required May be delegated to eviCore for some clients Oct 27, 2006 Master Precertification List (For Health Care Providers) Cigna Basic Standard All prior auth required May be delegated to eviCore for some clients Oct 27, 2006 Master Precertification List (For Health Care Providers) Cigna Complete/PHS+/Preferred All prior auth required May be delegated to eviCore for some clients Oct 27, 2006 Master Precertification List (For Health Care Providers) Cigna Musculoskeletal All prior auth required Mar 7, 2026 Cigna Commercial Prior Authorization Procedure Code List: Musculoskeletal - Joint Surgery Cigna Musculoskeletal All prior auth required Mar 7, 2026 Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs CarePlus Health Plans CarePlus Health Plans FL prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Humana D-SNP (FL) FL prior auth required Jan 1, 2027 1 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List Humana Humana D-SNP (IL) IL prior auth required Jan 1, 2027 Humana Dual Fully Integrated Illinois Prior Authorization and Notification List Humana Humana D-SNP (IN) IN prior auth required Jan 1, 2027 *New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List Humana Humana D-SNP (MI) MI prior auth required Jan 1, 2027 1 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List Humana Humana D-SNP (SC) SC prior auth required Jan 1, 2027 Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List Humana Humana D-SNP (VA) VA prior auth required Jan 1, 2027 Virginia Prior Authorization and Notification List Humana Humana Healthy Horizons KY prior auth required Jan 1, 2027 please visit Humana Healthy Horizons in Kentucky Clinical coverage policies. Humana Humana MA and D-SNP All prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Humana Puerto Rico MA and Dual Medicare-Medicaid PR prior auth required Nov 3, 2025 Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification Humana Musculoskeletal All prior auth required Humana Prior Authorization List (PAL): Musculoskeletal Services Humana Musculoskeletal All prior auth required Humana Prior Authorization List (PAL): Musculoskeletal Services Humana Musculoskeletal All prior auth required Humana Prior Authorization List (PAL): Musculoskeletal Services Humana Oak Street Health All prior auth required Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management
Payer coverage policies that name L8641 L8641 appears in 7 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, BlueCross BlueShield of South Carolina, Cigna, Premera Blue Cross.
Payer Policy Role in policy Reviewed Document Aetna Hammertoe Repair (0636)CannuLink intramedullary fusion device not covered Sep 11, 2026 payer document Aetna Metatarsal Phalangeal Joint Replacement (0708) covered if criteria are met Nov 24, 2025 payer document Blue Cross & Blue Shield of Mississippi Prosthetics (L.1.04.401) covered if criteria are met payer document Blue Cross & Blue Shield of Mississippi Synthetic Cartilage Implants For Joint Pain (A.7.01.160) unproven / investigational payer document BlueCross BlueShield of South Carolina Orthopedic Implants (CAM 385) listed, no stance Sep 1, 2026 payer document Cigna Metatarsophalangeal Joint Replacement (0446) covered if criteria are met Sep 15, 2025 payer document Premera Blue Cross (effective November 6, 2026) Cartilage Implants for Joint Pain (7.01.160) listed, no stance Jul 14, 2026 payer document
Medicaid fee-for-service Prior authorization required or conditional in OH, VA.
AZ: $363.14 (dme), effective Oct 1, 2026 CO: $441.02 (chp_plus, non-facility), effective Jul 1, 2026 IN: $357.13 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026 KY: $0.00 (asc), effective Jan 1, 2026 MD: $364.27 (dme), effective Apr 1, 2026 OH: $448.15 (dme), effective Jan 1, 2026 OK: $299.99 (dme), effective Jan 1, 2026 VA: $322.99 (medical), effective Jan 1, 2012 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026 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.