L1920 HCPCS code: Ankle foot orthosis, single upright with static or adjustable stop (phelps or perlstein type), custom fabricated
L1920 is the HCPCS Level II code for ankle foot orthosis, single upright with static or adjustable stop (phelps or perlstein type), custom fabricated. The 2026 Medicare DMEPOS fee schedule pays $374.16 to $761.40 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. Its average fee ranks 6 of 20 L19 codes (family range $102.92–$1,226.57).
Code details
| Field | Value |
|---|---|
| Section | L codes — Orthotic and prosthetic procedures and devices |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 38 — DMEPOS: orthotics, prosthetics, prosthetic devices and vision services |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 1982-01-01 |
| Last action effective | 2001-01-01 |
2026 Medicare DMEPOS fee schedule for L1920
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $374.16 | $761.40 | $535.64 | $401.73 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $374.16 | — |
| AL | — | $401.73 | — |
| AR | — | $415.96 | — |
| AZ | — | $418.92 | — |
| CA | — | $418.92 | — |
| CO | — | $505.28 | — |
| CT | — | $533.93 | — |
| DC | — | $401.73 | — |
| DE | — | $401.73 | — |
| FL | — | $401.73 | — |
| GA | — | $401.73 | — |
| HI | — | $400.10 | — |
| IA | — | $401.73 | — |
| ID | — | $514.91 | — |
| IL | — | $504.86 | — |
| IN | — | $504.86 | — |
| KS | — | $401.73 | — |
| KY | — | $401.73 | — |
| LA | — | $415.96 | — |
| MA | — | $533.93 | — |
| MD | — | $401.73 | — |
| ME | — | $533.93 | — |
| MI | — | $504.86 | — |
| MN | — | $504.86 | — |
| MO | — | $401.73 | — |
| MS | — | $401.73 | — |
| MT | — | $505.28 | — |
| NC | — | $401.73 | — |
| ND | — | $505.28 | — |
| NE | — | $401.73 | — |
| NH | — | $533.93 | — |
| NJ | — | $429.77 | — |
| NM | — | $415.96 | — |
| NV | — | $418.92 | — |
| NY | — | $429.77 | — |
| OH | — | $504.86 | — |
| OK | — | $415.96 | — |
| OR | — | $514.91 | — |
| PA | — | $401.73 | — |
| PR | — | $761.40 | — |
| RI | — | $533.93 | — |
| SC | — | $401.73 | — |
| SD | — | $505.28 | — |
| TN | — | $401.73 | — |
| TX | — | $415.96 | — |
| UT | — | $505.28 | — |
| VA | — | $401.73 | — |
| VI | — | $429.77 | — |
| VT | — | $533.93 | — |
| WA | — | $514.91 | — |
| WI | — | $504.86 | — |
| WV | — | $401.73 | — |
| WY | — | $505.28 | — |
How the L1920 fee compares
| Measure | Value |
|---|---|
| Rank among 20 L19 codes (lowest = 1) | 6 |
| Family fee range (average of state fees) | $102.92–$1,226.57 |
| Rural fee uplift | — |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 2 | Anatomic Consideration |
| outpatient hospital claims | 2 | Anatomic Consideration |
What changed for L1920
- 2026-01-01: Average state fee rose 2.0%: $447.68 to $456.64
- 1982-01-01: L1920 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 L1920?
L1920 is the HCPCS Level II code for ankle foot orthosis, single upright with static or adjustable stop (phelps or perlstein type), custom fabricated. Short descriptor: "Afo sing upright w/ adjust s".
How much does Medicare pay for L1920?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $374.16–$761.40. Rural fees can be higher.
Does Medicare cover L1920?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L1920 change in 2026?
The average non-rural state fee moved from $447.68 in 2025 to $456.64 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L1920 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)
- L1904 — Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated ($540.36–$990.72)
- 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)
- 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 L1920
- Watch L1920 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L1920
Sources: CMS HCPCS Level II release October 2025; 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.