`L8721` Receptor sole l8720 replace

Receptor sole for use with l8720, replacement, each

Medicare coverage: Carrier judgment
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 2 units per day (clinical), rationale: Nature of Equipment
Outpatient hospital: max 2 units per day (clinical), rationale: Nature of Equipment
DME supplier: max 2 units per day (clinical), rationale: Nature of Equipment

Payer policies and prior authorization for L8721

9 of 9 payer prior-auth lists that name L8721 require prior authorization or set conditions: CarePlus Health Plans, Humana.

Payer	Plan	State	Prior auth	Since	Source
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 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

Payer coverage policies that name L8721

L8721 appears in 7 coverage policies from Aetna, Anthem, Blue Shield of California, Capital Blue Cross, Premera Blue Cross, Regence.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Functional Electrical Stimulation and Neuromuscular Electrical Stimulation (0677) AxioBionics Wearable Therapy	not covered	Sep 10, 2026	payer document
Aetna	Lower Limb Prostheses (0578)	not covered	Oct 9, 2026	payer document
Anthem	External Lower Extremity Sensory Prosthetic Devices (OR-PR.00009)	unproven / investigational	Aug 13, 2026	payer document
Blue Shield of California	Biofeedback for Miscellaneous Indications (2.01.53)	listed, no stance		payer document
Capital Blue Cross	Experimental and Investigational Procedures (MP 4.002) Procedure codes: Miscellaneous	listed, no stance	Sep 1, 2026	payer document
Premera Blue Cross	Non-covered Experimental/Investigational Services Page \| 32 of 38 \| ∞	unproven / investigational	Oct 1, 2026	payer document
Regence	Lower Extremity Sensory Prostheses (Durable Medical Equipment 95)	listed, no stance	Nov 1, 2025	payer document

Recent prior-auth changes

Oct 31, 2024: PA removed, Cigna
Oct 31, 2024: PA removed, Cigna
Oct 8, 2024: PA added, humana:pa:commercial

Medicaid fee-for-service

Prior authorization required or conditional in CO, MS, OH.

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.

L8721 Receptor sole l8720 replace