L4397 HCPCS code: Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf
L4397 is the HCPCS Level II code for static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf. The 2026 Medicare DMEPOS fee schedule pays $197.90 to $241.56 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 8 of 11 L43 codes (family range $20.94–$353.29).
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 | 2014-01-01 |
| Last action effective | 2014-01-01 |
2026 Medicare DMEPOS fee schedule for L4397
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $197.90 | $241.56 | $245.21 | $183.91 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $197.90 | — |
| AL | — | $207.41 | — |
| AR | — | $207.40 | — |
| AZ | — | $197.90 | — |
| CA | — | $197.90 | — |
| CO | — | $204.74 | — |
| CT | — | $210.28 | — |
| DC | — | $201.26 | — |
| DE | — | $201.26 | — |
| FL | — | $207.41 | — |
| GA | — | $207.41 | — |
| HI | — | $197.90 | — |
| IA | — | $197.90 | — |
| ID | — | $197.90 | — |
| IL | — | $206.23 | — |
| IN | — | $206.23 | — |
| KS | — | $197.90 | — |
| KY | — | $207.41 | — |
| LA | — | $207.40 | — |
| MA | — | $210.28 | — |
| MD | — | $201.26 | — |
| ME | — | $210.28 | — |
| MI | — | $206.23 | — |
| MN | — | $206.23 | — |
| MO | — | $197.90 | — |
| MS | — | $207.41 | — |
| MT | — | $204.74 | — |
| NC | — | $207.41 | — |
| ND | — | $204.74 | — |
| NE | — | $197.90 | — |
| NH | — | $210.28 | — |
| NJ | — | $201.26 | — |
| NM | — | $207.40 | — |
| NV | — | $197.90 | — |
| NY | — | $201.26 | — |
| OH | — | $206.23 | — |
| OK | — | $207.40 | — |
| OR | — | $197.90 | — |
| PA | — | $201.26 | — |
| PR | — | $241.56 | — |
| RI | — | $210.28 | — |
| SC | — | $207.41 | — |
| SD | — | $204.74 | — |
| TN | — | $207.41 | — |
| TX | — | $207.40 | — |
| UT | — | $204.74 | — |
| VA | — | $201.26 | — |
| VI | — | $201.26 | — |
| VT | — | $210.28 | — |
| WA | — | $197.90 | — |
| WI | — | $206.23 | — |
| WV | — | $201.26 | — |
| WY | — | $204.74 | — |
How the L4397 fee compares
| Measure | Value |
|---|---|
| Rank among 11 L43 codes (lowest = 1) | 8 |
| Family fee range (average of state fees) | $20.94–$353.29 |
| 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 L4397
- 2026-01-01: Average state fee rose 2.0%: $200.73 to $204.74
- 2014-01-01: L4397 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 L4397?
L4397 is the HCPCS Level II code for static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf. Short descriptor: "Static or dynami afo pre ots".
How much does Medicare pay for L4397?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $197.90–$241.56. Rural fees can be higher.
Does Medicare cover L4397?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L4397 change in 2026?
The average non-rural state fee moved from $200.73 in 2025 to $204.74 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L4397 can be billed per day?
2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).
Related L43 codes
- L4350 — Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf ($79.39–$207.41)
- L4360 — Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise ($318.18–$424.24)
- L4361 — Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf ($318.18–$424.24)
- L4370 — Pneumatic full leg splint, prefabricated, off-the-shelf ($203.79–$289.25)
- L4386 — Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise ($190.16–$209.24)
- L4387 — Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf ($190.16–$209.24)
- L4392 — Replacement, soft interface material, static afo ($27.75–$33.87)
- L4394 — Replace soft interface material, foot drop splint ($20.22–$24.74)
- L4396 — Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise ($197.90–$241.56)
- L4398 — Foot drop splint, recumbent positioning device, prefabricated, off-the-shelf ($91.13–$111.17)
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Next steps
- Run a reimbursement report for a device billed under L4397
- Watch L4397 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L4397
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.