L1951 HCPCS code: Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L1951 is the HCPCS Level II code for ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise. The 2026 Medicare DMEPOS fee schedule pays $1,007.37 to $1,108.09 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 13% from 2022 to 2024 (13,271 to 11,539 services). In 2024, 1,925 suppliers billed Medicare for L1951 (purchases), serving 10,011 beneficiaries; Florida, California, Pennsylvania accounted for 18% of services. Its average fee ranks 16 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 | 2004-01-01 |
| Last action effective | 2025-04-01 |
2026 Medicare DMEPOS fee schedule for L1951
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $1,007.37 | $1,108.09 | $1,229.35 | $922.01 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $1,007.37 | — |
| AL | — | $1,037.71 | — |
| AR | — | $1,037.61 | — |
| AZ | — | $1,007.37 | — |
| CA | — | $1,007.37 | — |
| CO | — | $1,043.45 | — |
| CT | — | $1,007.37 | — |
| DC | — | $1,007.37 | — |
| DE | — | $1,007.37 | — |
| FL | — | $1,037.71 | — |
| GA | — | $1,037.71 | — |
| HI | — | $1,007.37 | — |
| IA | — | $1,027.04 | — |
| ID | — | $1,007.37 | — |
| IL | — | $1,032.09 | — |
| IN | — | $1,032.09 | — |
| KS | — | $1,027.04 | — |
| KY | — | $1,037.71 | — |
| LA | — | $1,037.61 | — |
| MA | — | $1,007.37 | — |
| MD | — | $1,007.37 | — |
| ME | — | $1,007.37 | — |
| MI | — | $1,032.09 | — |
| MN | — | $1,032.09 | — |
| MO | — | $1,027.04 | — |
| MS | — | $1,037.71 | — |
| MT | — | $1,043.45 | — |
| NC | — | $1,037.71 | — |
| ND | — | $1,043.45 | — |
| NE | — | $1,027.04 | — |
| NH | — | $1,007.37 | — |
| NJ | — | $1,007.37 | — |
| NM | — | $1,037.61 | — |
| NV | — | $1,007.37 | — |
| NY | — | $1,007.37 | — |
| OH | — | $1,032.09 | — |
| OK | — | $1,037.61 | — |
| OR | — | $1,007.37 | — |
| PA | — | $1,007.37 | — |
| PR | — | $1,108.09 | — |
| RI | — | $1,007.37 | — |
| SC | — | $1,037.71 | — |
| SD | — | $1,043.45 | — |
| TN | — | $1,037.71 | — |
| TX | — | $1,037.61 | — |
| UT | — | $1,043.45 | — |
| VA | — | $1,007.37 | — |
| VI | — | $1,108.09 | — |
| VT | — | $1,007.37 | — |
| WA | — | $1,007.37 | — |
| WI | — | $1,032.09 | — |
| WV | — | $1,007.37 | — |
| WY | — | $1,043.45 | — |
How the L1951 fee compares
| Measure | Value |
|---|---|
| Rank among 20 L19 codes (lowest = 1) | 16 |
| Family fee range (average of state fees) | $102.92–$1,226.57 |
| Rural fee uplift | — |
Who bills L1951 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 1,925 |
| Referring clinicians | 8,522 |
| Medicare beneficiaries | 10,011 |
| States with claims | 51 |
| Share of services in top 3 states (Florida, California, Pennsylvania) | 18% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 2,108 | 11,552 |
| 2023 | 2,041 | 11,735 |
| 2024 | 1,925 | 10,011 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L1951, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 13,271 | 11,552 | $877.74 | $681.23 |
| 2023 | 13,533 | 11,735 | $952.58 | $736.29 |
| 2024 | 11,539 | 10,011 | $979.11 | $757.11 |
States with the most L1951 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 767 | $769.10 |
| California | 713 | $745.77 |
| Pennsylvania | 606 | $749.98 |
| Texas | 601 | $769.36 |
| Illinois | 543 | $760.49 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 2 | Anatomic Consideration |
| outpatient hospital claims | 2 | Anatomic Consideration |
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:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| A52.16 | Charcot's arthropathy (tabetic) | 1 |
| E08.610 | Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy | 1 |
| E09.610 | Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy | 1 |
| E10.610 | Type 1 diabetes mellitus with diabetic neuropathic arthropathy | 1 |
| E11.610 | Type 2 diabetes mellitus with diabetic neuropathic arthropathy | 1 |
| M14.671 | Charcot's joint, right ankle and foot | 1 |
| M14.672 | Charcot's joint, left ankle and foot | 1 |
| M24.571 | Contracture, right ankle | 1 |
| M24.572 | Contracture, left ankle | 1 |
| M24.574 | Contracture, right foot | 1 |
Showing 10 of 12. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for L1951
- April 2025: Descriptor revised (Was: Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, includes fitting and adjustment)
- 2026-01-01: Average state fee rose 2.0%: $1,006.83 to $1,026.97
- 2004-01-01: L1951 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 L1951?
L1951 is the HCPCS Level II code for ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise. Short descriptor: "Afo spiral prefab custom".
How much does Medicare pay for L1951?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $1,007.37–$1,108.09. Rural fees can be higher.
Does Medicare cover L1951?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for L1951?
Medicare policy articles that cite L1951 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 L1951 change in 2026?
The average non-rural state fee moved from $1,006.83 in 2025 to $1,026.97 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L1951 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)
- 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)
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under L1951
- Watch L1951 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L1951
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.