L4080 HCPCS code: Replace metal bands kafo, proximal thigh
L4080 is the HCPCS Level II code for replace metal bands kafo, proximal thigh. The 2026 Medicare DMEPOS fee schedule pays $116.23 to $154.98 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. In 2022, 11 suppliers billed Medicare for L4080 (purchases), serving 11 beneficiaries. Its average fee ranks 2 of 12 L40 codes (family range $117.32–$1,638.51).
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 | 1986-01-01 |
| Last action effective | 1996-01-01 |
2026 Medicare DMEPOS fee schedule for L4080
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $116.23 | $154.98 | $154.98 | $116.23 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $128.91 | — |
| AL | — | $122.83 | — |
| AR | — | $116.23 | — |
| AZ | — | $132.80 | — |
| CA | — | $132.80 | — |
| CO | — | $116.23 | — |
| CT | — | $154.98 | — |
| DC | — | $132.66 | — |
| DE | — | $132.66 | — |
| FL | — | $122.83 | — |
| GA | — | $122.83 | — |
| HI | — | $137.77 | — |
| IA | — | $140.81 | — |
| ID | — | $137.64 | — |
| IL | — | $122.09 | — |
| IN | — | $122.09 | — |
| KS | — | $140.81 | — |
| KY | — | $122.83 | — |
| LA | — | $116.23 | — |
| MA | — | $154.98 | — |
| MD | — | $132.66 | — |
| ME | — | $154.98 | — |
| MI | — | $122.09 | — |
| MN | — | $122.09 | — |
| MO | — | $140.81 | — |
| MS | — | $122.83 | — |
| MT | — | $116.23 | — |
| NC | — | $122.83 | — |
| ND | — | $116.23 | — |
| NE | — | $140.81 | — |
| NH | — | $154.98 | — |
| NJ | — | $118.79 | — |
| NM | — | $116.23 | — |
| NV | — | $132.80 | — |
| NY | — | $118.79 | — |
| OH | — | $122.09 | — |
| OK | — | $116.23 | — |
| OR | — | $137.64 | — |
| PA | — | $132.66 | — |
| PR | — | $142.76 | — |
| RI | — | $154.98 | — |
| SC | — | $122.83 | — |
| SD | — | $116.23 | — |
| TN | — | $122.83 | — |
| TX | — | $116.23 | — |
| UT | — | $116.23 | — |
| VA | — | $132.66 | — |
| VI | — | $118.79 | — |
| VT | — | $154.98 | — |
| WA | — | $137.64 | — |
| WI | — | $122.09 | — |
| WV | — | $132.66 | — |
| WY | — | $116.23 | — |
How the L4080 fee compares
| Measure | Value |
|---|---|
| Rank among 12 L40 codes (lowest = 1) | 2 |
| Family fee range (average of state fees) | $117.32–$1,638.51 |
| Rural fee uplift | — |
Who bills L4080 (2022)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 11 |
| Referring clinicians | 11 |
| Medicare beneficiaries | 11 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L4080, 2022–2022
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 12 | 11 | $111.46 | $79.78 |
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 L4080
- 2026-01-01: Average state fee rose 2.0%: $126.89 to $129.43
- 1986-01-01: L4080 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 L4080?
L4080 is the HCPCS Level II code for replace metal bands kafo, proximal thigh. Short descriptor: "Repl met band kafo-afo prox".
How much does Medicare pay for L4080?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $116.23–$154.98. Rural fees can be higher.
Does Medicare cover L4080?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for L4080?
Medicare policy articles that cite L4080 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 L4080 change in 2026?
The average non-rural state fee moved from $126.89 in 2025 to $129.43 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L4080 can be billed per day?
2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).
Related L40 codes
- L4000 — Replace girdle for spinal orthosis (ctlso or so) ($1,332.49–$2,202.71)
- L4002 — Replacement strap, any orthosis, includes all components, any length, any type
- L4010 — Replace trilateral socket brim ($771.19–$1,290.07)
- L4020 — Replace quadrilateral socket brim, molded to patient model ($989.77–$1,433.34)
- L4030 — Replace quadrilateral socket brim, custom fitted ($580.17–$1,142.13)
- L4040 — Replace molded thigh lacer, for custom fabricated orthosis only ($469.07–$1,370.51)
- L4045 — Replace non-molded thigh lacer, for custom fabricated orthosis only ($376.94–$738.06)
- L4050 — Replace molded calf lacer, for custom fabricated orthosis only ($474.40–$1,142.13)
- L4055 — Replace non-molded calf lacer, for custom fabricated orthosis only ($307.20–$686.22)
- L4060 — Replace high roll cuff ($304.58–$689.86)
- L4070 — Replace proximal and distal upright for kafo ($304.58–$949.20)
- L4090 — Replace metal bands kafo-afo, calf or distal thigh ($103.77–$142.76)
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 L4080
- Watch L4080 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L4080
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.