L1904 HCPCS code: Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated

L1904 is the HCPCS Level II code for ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated. The 2026 Medicare DMEPOS fee schedule pays $540.36 to $990.72 depending on the state. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 2 per day on DME suppliers. Medicare volume fell 24% from 2022 to 2024 (168 to 127 services). In 2024, 73 suppliers billed Medicare for L1904 (purchases), serving 106 beneficiaries. Its average fee ranks 10 of 20 L19 codes (family range $102.92–$1,226.57).

Code details

2026 Medicare DMEPOS fee schedule for L1904

How the L1904 fee compares

Who bills L1904 (2024)

Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.

Medicare utilization for L1904, 2022–2024

States with the most L1904 services (2024)

NCCI unit limits (MUE)

Medicare policy articles for this code

• A52457: Ankle-Foot/Knee-Ankle-Foot Orthoses - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance

Covered diagnoses (12 ICD-10-CM codes)

The diagnoses most often listed as covered in the policy articles above:

Showing 10 of 12. The full list, non-covered diagnoses and CSV export are in Caduvo.

What changed for L1904

• 2026-01-01: Average state fee rose 2.0%: $590.50 to $602.31
• 1988-01-01: L1904 added to HCPCS Level II
• Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01

Frequently asked questions

What is HCPCS code L1904?

L1904 is the HCPCS Level II code for ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated. Short descriptor: "Afo molded ankle gauntlet".

How much does Medicare pay for L1904?

Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $540.36–$990.72. Rural fees can be higher.

Does Medicare cover L1904?

Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.

Which diagnoses support coverage for L1904?

Medicare policy articles that cite L1904 list 12 covered ICD-10-CM diagnosis codes across 1 article. The most cited include A52.16 (Charcot's arthropathy (tabetic)), E08.610 (Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy), E09.610 (Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.

Did the Medicare fee for L1904 change in 2026?

The average non-rural state fee moved from $590.50 in 2025 to $602.31 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.

How many units of L1904 can be billed per day?

2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).

Related L19 codes

• L1900 — Ankle foot orthosis, spring wire, dorsiflexion assist calf band, custom fabricated ($310.01–$398.09)
• L1902 — Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf ($85.68–$122.31)
• L1906 — Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf ($138.20–$318.48)
• L1907 — Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated ($674.95–$742.46)
• L1910 — Ankle foot orthosis, posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment ($307.30–$590.09)
• L1920 — Ankle foot orthosis, single upright with static or adjustable stop (phelps or perlstein type), custom fabricated ($374.16–$761.40)
• L1930 — Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment ($225.00–$459.82)
• L1932 — Ankle foot orthosis, rigid anterior tibial section, total carbon fiber or equal material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise ($1,070.39–$1,177.42)
• L1933 — Ankle foot orthosis, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, off-the-shelf ($1,070.39–$1,177.42)
• L1940 — Ankle foot orthosis, plastic or other material, custom fabricated ($568.30–$1,522.87)
• L1945 — Ankle foot orthosis, plastic, rigid anterior tibial section (floor reaction), custom fabricated ($780.45–$1,589.54)
• L1950 — Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic, custom fabricated ($855.92–$1,328.25)

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Next steps

• Run a reimbursement report for a device billed under L1904
• Watch L1904 for fee, coverage and descriptor changes
• Build a full Medicare revenue model for L1904

Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.

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