L4631 HCPCS code: Ankle foot orthosis, walking boot type, varus/valgus correction, rocker bottom, anterior tibial shell, soft interface, custom arch support, plastic or other material, includes straps and closures, custom fabricated
L4631 is the HCPCS Level II code for ankle foot orthosis, walking boot type, varus/valgus correction, rocker bottom, anterior tibial shell, soft interface, custom arch support, plastic or other material, includes straps and closures, custom fabricated. The 2026 Medicare DMEPOS fee schedule pays $1,710.05 to $3,027.97 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.
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 | 2011-01-01 |
| Last action effective | 2011-01-01 |
2026 Medicare DMEPOS fee schedule for L4631
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $1,710.05 | $3,027.97 | $2,257.57 | $1,693.18 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $2,412.72 | — |
| AL | — | $1,843.94 | — |
| AR | — | $1,827.50 | — |
| AZ | — | $2,257.57 | — |
| CA | — | $2,257.57 | — |
| CO | — | $1,710.05 | — |
| CT | — | $1,967.57 | — |
| DC | — | $1,912.64 | — |
| DE | — | $1,912.64 | — |
| FL | — | $1,843.94 | — |
| GA | — | $1,843.94 | — |
| HI | — | $2,542.49 | — |
| IA | — | $1,760.00 | — |
| ID | — | $1,834.95 | — |
| IL | — | $1,811.67 | — |
| IN | — | $1,811.67 | — |
| KS | — | $1,760.00 | — |
| KY | — | $1,843.94 | — |
| LA | — | $1,827.50 | — |
| MA | — | $1,967.57 | — |
| MD | — | $1,912.64 | — |
| ME | — | $1,967.57 | — |
| MI | — | $1,811.67 | — |
| MN | — | $1,811.67 | — |
| MO | — | $1,760.00 | — |
| MS | — | $1,843.94 | — |
| MT | — | $1,710.05 | — |
| NC | — | $1,843.94 | — |
| ND | — | $1,710.05 | — |
| NE | — | $1,760.00 | — |
| NH | — | $1,967.57 | — |
| NJ | — | $2,160.48 | — |
| NM | — | $1,827.50 | — |
| NV | — | $2,257.57 | — |
| NY | — | $2,160.48 | — |
| OH | — | $1,811.67 | — |
| OK | — | $1,827.50 | — |
| OR | — | $1,834.95 | — |
| PA | — | $1,912.64 | — |
| PR | — | $3,027.97 | — |
| RI | — | $1,967.57 | — |
| SC | — | $1,843.94 | — |
| SD | — | $1,710.05 | — |
| TN | — | $1,843.94 | — |
| TX | — | $1,827.50 | — |
| UT | — | $1,710.05 | — |
| VA | — | $1,912.64 | — |
| VI | — | $2,181.33 | — |
| VT | — | $1,967.57 | — |
| WA | — | $1,834.95 | — |
| WI | — | $1,811.67 | — |
| WV | — | $1,912.64 | — |
| WY | — | $1,710.05 | — |
How the L4631 fee compares
| Measure | Value |
|---|---|
| Rank among 1 L46 codes (lowest = 1) | 1 |
| Family fee range (average of state fees) | $1,926.48–$1,926.48 |
| 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 L4631
- 2026-01-01: Average state fee rose 2.0%: $1,888.71 to $1,926.48
- 2011-01-01: L4631 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 L4631?
L4631 is the HCPCS Level II code for ankle foot orthosis, walking boot type, varus/valgus correction, rocker bottom, anterior tibial shell, soft interface, custom arch support, plastic or other material, includes straps and closures, custom fabricated. Short descriptor: "Afo, walk boot type, cus fab".
How much does Medicare pay for L4631?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $1,710.05–$3,027.97. Rural fees can be higher.
Does Medicare cover L4631?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L4631 change in 2026?
The average non-rural state fee moved from $1,888.71 in 2025 to $1,926.48 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L4631 can be billed per day?
2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).
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Next steps
- Run a reimbursement report for a device billed under L4631
- Watch L4631 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L4631
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.