L4090 HCPCS code: Replace metal bands kafo-afo, calf or distal thigh
L4090 is the HCPCS Level II code for replace metal bands kafo-afo, calf or distal thigh. The 2026 Medicare DMEPOS fee schedule pays $103.77 to $142.76 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 4 per day on DME suppliers. Its average fee ranks 1 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 | 1985-01-01 |
| Last action effective | 1996-01-01 |
2026 Medicare DMEPOS fee schedule for L4090
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $103.77 | $142.76 | $138.37 | $103.77 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $122.52 | — |
| AL | — | $108.72 | — |
| AR | — | $131.28 | — |
| AZ | — | $126.49 | — |
| CA | — | $126.49 | — |
| CO | — | $103.77 | — |
| CT | — | $120.73 | — |
| DC | — | $104.67 | — |
| DE | — | $104.67 | — |
| FL | — | $108.72 | — |
| GA | — | $108.72 | — |
| HI | — | $131.01 | — |
| IA | — | $133.07 | — |
| ID | — | $138.25 | — |
| IL | — | $103.88 | — |
| IN | — | $103.88 | — |
| KS | — | $133.07 | — |
| KY | — | $108.72 | — |
| LA | — | $131.28 | — |
| MA | — | $120.73 | — |
| MD | — | $104.67 | — |
| ME | — | $120.73 | — |
| MI | — | $103.88 | — |
| MN | — | $103.88 | — |
| MO | — | $133.07 | — |
| MS | — | $108.72 | — |
| MT | — | $103.77 | — |
| NC | — | $108.72 | — |
| ND | — | $103.77 | — |
| NE | — | $133.07 | — |
| NH | — | $120.73 | — |
| NJ | — | $123.50 | — |
| NM | — | $131.28 | — |
| NV | — | $126.49 | — |
| NY | — | $123.50 | — |
| OH | — | $103.88 | — |
| OK | — | $131.28 | — |
| OR | — | $138.25 | — |
| PA | — | $104.67 | — |
| PR | — | $142.76 | — |
| RI | — | $120.73 | — |
| SC | — | $108.72 | — |
| SD | — | $103.77 | — |
| TN | — | $108.72 | — |
| TX | — | $131.28 | — |
| UT | — | $103.77 | — |
| VA | — | $104.67 | — |
| VI | — | $123.50 | — |
| VT | — | $120.73 | — |
| WA | — | $138.25 | — |
| WI | — | $103.88 | — |
| WV | — | $104.67 | — |
| WY | — | $103.77 | — |
How the L4090 fee compares
| Measure | Value |
|---|---|
| Rank among 12 L40 codes (lowest = 1) | 1 |
| Family fee range (average of state fees) | $117.32–$1,638.51 |
| Rural fee uplift | — |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 4 | Nature of Equipment |
| outpatient hospital claims | 4 | Nature of Equipment |
What changed for L4090
- 2026-01-01: Average state fee rose 2.0%: $115.02 to $117.32
- 1985-01-01: L4090 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 L4090?
L4090 is the HCPCS Level II code for replace metal bands kafo-afo, calf or distal thigh. Short descriptor: "Repl met band kafo-afo calf/".
How much does Medicare pay for L4090?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $103.77–$142.76. Rural fees can be higher.
Does Medicare cover L4090?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L4090 change in 2026?
The average non-rural state fee moved from $115.02 in 2025 to $117.32 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L4090 can be billed per day?
4 on DME suppliers; 4 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)
- L4080 — Replace metal bands kafo, proximal thigh ($116.23–$154.98)
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Next steps
- Run a reimbursement report for a device billed under L4090
- Watch L4090 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L4090
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.