L4130 HCPCS code: Replace pretibial shell
L4130 is the HCPCS Level II code for replace pretibial shell. The 2026 Medicare DMEPOS fee schedule pays $523.52 to $815.92 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 2024, 8 suppliers billed Medicare for L4130 (purchases), serving 15 beneficiaries. Its average fee ranks 3 of 3 L41 codes (family range $111.18–$640.48).
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 | 1984-01-01 |
| Last action effective | 1996-01-01 |
2026 Medicare DMEPOS fee schedule for L4130
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $523.52 | $815.92 | $760.15 | $570.11 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $763.03 | — |
| AL | — | $670.68 | — |
| AR | — | $664.47 | — |
| AZ | — | $760.15 | — |
| CA | — | $760.15 | — |
| CO | — | $655.21 | — |
| CT | — | $570.11 | — |
| DC | — | $580.60 | — |
| DE | — | $580.60 | — |
| FL | — | $670.68 | — |
| GA | — | $670.68 | — |
| HI | — | $815.92 | — |
| IA | — | $628.50 | — |
| ID | — | $760.15 | — |
| IL | — | $589.05 | — |
| IN | — | $589.05 | — |
| KS | — | $628.50 | — |
| KY | — | $670.68 | — |
| LA | — | $664.47 | — |
| MA | — | $570.11 | — |
| MD | — | $580.60 | — |
| ME | — | $570.11 | — |
| MI | — | $589.05 | — |
| MN | — | $589.05 | — |
| MO | — | $628.50 | — |
| MS | — | $670.68 | — |
| MT | — | $655.21 | — |
| NC | — | $670.68 | — |
| ND | — | $655.21 | — |
| NE | — | $628.50 | — |
| NH | — | $570.11 | — |
| NJ | — | $570.11 | — |
| NM | — | $664.47 | — |
| NV | — | $760.15 | — |
| NY | — | $570.11 | — |
| OH | — | $589.05 | — |
| OK | — | $664.47 | — |
| OR | — | $760.15 | — |
| PA | — | $580.60 | — |
| PR | — | $523.52 | — |
| RI | — | $570.11 | — |
| SC | — | $670.68 | — |
| SD | — | $655.21 | — |
| TN | — | $670.68 | — |
| TX | — | $664.47 | — |
| UT | — | $655.21 | — |
| VA | — | $580.60 | — |
| VI | — | $570.11 | — |
| VT | — | $570.11 | — |
| WA | — | $760.15 | — |
| WI | — | $589.05 | — |
| WV | — | $580.60 | — |
| WY | — | $655.21 | — |
How the L4130 fee compares
| Measure | Value |
|---|---|
| Rank among 3 L41 codes (lowest = 1) | 3 |
| Family fee range (average of state fees) | $111.18–$640.48 |
| Rural fee uplift | — |
Who bills L4130 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 8 |
| Referring clinicians | 15 |
| Medicare beneficiaries | 15 |
| States with claims | 0 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 15 | 19 |
| 2023 | 6 | 12 |
| 2024 | 8 | 15 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L4130, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 22 | 19 | $541.32 | $427.81 |
| 2023 | 14 | 12 | $618.67 | $485.04 |
| 2024 | 22 | 15 | $674.46 | $522.22 |
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 L4130
- 2026-01-01: Average state fee rose 2.0%: $627.92 to $640.48
- 1984-01-01: L4130 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 L4130?
L4130 is the HCPCS Level II code for replace pretibial shell. Short descriptor: "Replace pretibial shell".
How much does Medicare pay for L4130?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $523.52–$815.92. Rural fees can be higher.
Does Medicare cover L4130?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for L4130?
Medicare policy articles that cite L4130 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 L4130 change in 2026?
The average non-rural state fee moved from $627.92 in 2025 to $640.48 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L4130 can be billed per day?
2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).
Related L41 codes
- L4100 — Replace leather cuff kafo, proximal thigh ($119.86–$171.33)
- L4110 — Replace leather cuff kafo-afo, calf or distal thigh ($97.45–$171.33)
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 L4130
- Watch L4130 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L4130
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.