| Code | Description | States | Median rate |
|---|---|---|---|
| L2000 | Knee ankle foot orthosis, single upright, free knee, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar 'ak' orthosis), custom fabricated | 44 | $985.79 |
| L2005 | Knee ankle foot orthosis, any material, single or double upright, stance control, automatic lock and swing phase release, any type activation, includes ankle joint, any type, custom fabricated | 42 | $3,932.17 |
| L2006 | Knee ankle foot device, any material, single or double upright, swing and stance phase microprocessor control with adjustability, includes all components (e.g., sensors, batteries, charger), any type activation, with or without ankle joint(s), custom fabricated | 13 | $36,413.75 |
| L2010 | Knee ankle foot orthosis, single upright, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar 'ak' orthosis), without knee joint, custom fabricated | 43 | $883.52 |
| L2020 | Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs (double bar 'ak' orthosis), custom fabricated | 44 | $1,120.42 |
| L2030 | Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs, (double bar 'ak' orthosis), without knee joint, custom fabricated | 44 | $1,035.15 |
| L2034 | Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, medial lateral rotation control, with or without free motion ankle, custom fabricated | 40 | $1,983.54 |
| L2035 | Knee ankle foot orthosis, full plastic, static (pediatric size), without free motion ankle, prefabricated, includes fitting and adjustment | 43 | $165.07 |
| L2036 | Knee ankle foot orthosis, full plastic, double upright, with or without free motion knee, with or without free motion ankle, custom fabricated | 44 | $1,767.49 |
| L2037 | Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, with or without free motion ankle, custom fabricated | 43 | $1,648.97 |
| L2038 | Knee ankle foot orthosis, full plastic, with or without free motion knee, multi-axis ankle, custom fabricated | 43 | $1,410.67 |
| L2040 | Hip knee ankle foot orthosis, torsion control, bilateral rotation straps, pelvic band/belt, custom fabricated | 43 | $175.18 |
| L2050 | Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, hip joint, pelvic band/belt, custom fabricated | 44 | $440.54 |
| L2060 | Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, ball bearing hip joint, pelvic band/ belt, custom fabricated | 43 | $554.32 |
| L2070 | Hip knee ankle foot orthosis, torsion control, unilateral rotation straps, pelvic band/belt, custom fabricated | 42 | $132.96 |
| L2080 | Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, hip joint, pelvic band/belt, custom fabricated | 42 | $354.71 |
| L2090 | Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, ball bearing hip joint, pelvic band/ belt, custom fabricated | 42 | $445.24 |
| L2106 | Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, thermoplastic type casting material, custom fabricated | 43 | $670.85 |
| L2108 | Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, custom fabricated | 45 | $1,045.51 |
| L2112 | Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment | 45 | $470.99 |
| L2114 | Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment | 45 | $589.77 |
| L2116 | Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, rigid, prefabricated, includes fitting and adjustment | 45 | $709.96 |
| L2126 | Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, thermoplastic type casting material, custom fabricated | 42 | $1,194.98 |
| L2128 | Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, custom fabricated | 42 | $1,631.45 |
| L2132 | Kafo, fracture orthosis, femoral fracture cast orthosis, soft, prefabricated, includes fitting and adjustment | 42 | $776.71 |
| L2134 | Kafo, fracture orthosis, femoral fracture cast orthosis, semi-rigid, prefabricated, includes fitting and adjustment | 43 | $954.28 |
| L2136 | Kafo, fracture orthosis, femoral fracture cast orthosis, rigid, prefabricated, includes fitting and adjustment | 43 | $1,168.68 |
| L2180 | Addition to lower extremity fracture orthosis, plastic shoe insert with ankle joints | 45 | $110.26 |
| L2182 | Addition to lower extremity fracture orthosis, drop lock knee joint | 45 | $92.27 |
| L2184 | Addition to lower extremity fracture orthosis, limited motion knee joint | 44 | $116.24 |
| L2186 | Addition to lower extremity fracture orthosis, adjustable motion knee joint, lerman type | 44 | $141.83 |
| L2188 | Addition to lower extremity fracture orthosis, quadrilateral brim | 43 | $297.88 |
| L2190 | Addition to lower extremity fracture orthosis, waist belt | 43 | $80.53 |
| L2192 | Addition to lower extremity fracture orthosis, hip joint, pelvic band, thigh flange, and pelvic belt | 43 | $331.02 |
| L2200 | Addition to lower extremity, limited ankle motion, each joint | 45 | $45.79 |
| L2210 | Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint | 45 | $63.27 |
| L2220 | Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint | 45 | $77.18 |
| L2230 | Addition to lower extremity, split flat caliper stirrups and plate attachment | 45 | $72.62 |
| L2232 | Addition to lower extremity orthosis, rocker bottom for total contact ankle foot orthosis, for custom fabricated orthosis only | 38 | $95.50 |
| L2240 | Addition to lower extremity, round caliper and plate attachment | 44 | $86.43 |
| L2250 | Addition to lower extremity, foot plate, molded to patient model, stirrup attachment | 45 | $343.90 |
| L2260 | Addition to lower extremity, reinforced solid stirrup (scott-craig type) | 45 | $186.10 |
| L2265 | Addition to lower extremity, long tongue stirrup | 44 | $112.77 |
| L2270 | Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad | 44 | $51.11 |
| L2275 | Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined | 44 | $121.50 |
| L2280 | Addition to lower extremity, molded inner boot | 45 | $418.48 |
| L2300 | Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable | 44 | $264.51 |
| L2310 | Addition to lower extremity, abduction bar-straight | 45 | $121.09 |
| L2320 | Addition to lower extremity, non-molded lacer, for custom fabricated orthosis only | 45 | $200.97 |
| L2330 | Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only | 45 | $395.94 |
| L2335 | Addition to lower extremity, anterior swing band | 45 | $244.45 |
| L2340 | Addition to lower extremity, pre-tibial shell, molded to patient model | 44 | $436.52 |
| L2350 | Addition to lower extremity, prosthetic type, (bk) socket, molded to patient model, (used for 'ptb' 'afo' orthoses) | 45 | $882.29 |
| L2360 | Addition to lower extremity, extended steel shank | 44 | $50.17 |
| L2370 | Addition to lower extremity, patten bottom | 44 | $279.07 |
| L2375 | Addition to lower extremity, torsion control, ankle joint and half solid stirrup | 43 | $112.02 |
| L2380 | Addition to lower extremity, torsion control, straight knee joint, each joint | 43 | $120.25 |
| L2385 | Addition to lower extremity, straight knee joint, heavy duty, each joint | 44 | $128.60 |
| L2387 | Addition to lower extremity, polycentric knee joint, for custom fabricated knee ankle foot orthosis, each joint | 39 | $175.39 |
| L2390 | Addition to lower extremity, offset knee joint, each joint | 43 | $103.11 |
| L2395 | Addition to lower extremity, offset knee joint, heavy duty, each joint | 44 | $147.59 |
| L2397 | Addition to lower extremity orthosis, suspension sleeve | 44 | $111.53 |
| L2405 | Addition to knee joint, drop lock, each | 45 | $81.38 |
| L2415 | Addition to knee lock with integrated release mechanism (bail, cable, or equal), any material, each joint | 45 | $116.55 |
| L2425 | Addition to knee joint, disc or dial lock for adjustable knee flexion, each joint | 45 | $133.80 |
| L2430 | Addition to knee joint, ratchet lock for active and progressive knee extension, each joint | 44 | $137.54 |
| L2492 | Addition to knee joint, lift loop for drop lock ring | 44 | $103.04 |
| L2500 | Addition to lower extremity, thigh/weight bearing, gluteal/ ischial weight bearing, ring | 44 | $292.30 |
| L2510 | Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, molded to patient model | 44 | $717.93 |
| L2520 | Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, custom fitted | 44 | $454.52 |
| L2525 | Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim molded to patient model | 42 | $1,186.01 |
| L2526 | Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim, custom fitted | 44 | $678.32 |
| L2530 | Addition to lower extremity, thigh-weight bearing, lacer, non-molded | 45 | $223.84 |
| L2540 | Addition to lower extremity, thigh/weight bearing, lacer, molded to patient model | 44 | $392.41 |
| L2550 | Addition to lower extremity, thigh/weight bearing, high roll cuff | 45 | $280.53 |
| L2570 | Addition to lower extremity, pelvic control, hip joint, clevis type two position joint, each | 44 | $462.02 |
| L2580 | Addition to lower extremity, pelvic control, pelvic sling | 44 | $440.67 |
| L2600 | Addition to lower extremity, pelvic control, hip joint, clevis type, or thrust bearing, free, each | 45 | $202.63 |
| L2610 | Addition to lower extremity, pelvic control, hip joint, clevis or thrust bearing, lock, each | 45 | $233.93 |
| L2620 | Addition to lower extremity, pelvic control, hip joint, heavy duty, each | 45 | $278.26 |
| L2622 | Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each | 43 | $296.99 |
| L2624 | Addition to lower extremity, pelvic control, hip joint, adjustable flexion, extension, abduction control, each | 44 | $321.21 |
| L2627 | Addition to lower extremity, pelvic control, plastic, molded to patient model, reciprocating hip joint and cables | 43 | $1,677.67 |
| L2628 | Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables | 43 | $1,653.06 |
| L2630 | Addition to lower extremity, pelvic control, band and belt, unilateral | 43 | $235.54 |
| L2640 | Addition to lower extremity, pelvic control, band and belt, bilateral | 45 | $311.99 |
| L2650 | Addition to lower extremity, pelvic and thoracic control, gluteal pad, each | 44 | $119.17 |
| L2660 | Addition to lower extremity, thoracic control, thoracic band | 43 | $171.34 |
| L2670 | Addition to lower extremity, thoracic control, paraspinal uprights | 43 | $164.31 |
| L2680 | Addition to lower extremity, thoracic control, lateral support uprights | 45 | $153.90 |
| L2750 | Addition to lower extremity orthosis, plating chrome or nickel, per bar | 43 | $81.64 |
| L2755 | Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only | 42 | $123.48 |
| L2760 | Addition to lower extremity orthosis, extension, per extension, per bar (for lineal adjustment for growth) | 45 | $58.52 |
| L2768 | Orthotic side bar disconnect device, per bar | 42 | $125.01 |
| L2780 | Addition to lower extremity orthosis, non-corrosive finish, per bar | 44 | $63.88 |
| L2785 | Addition to lower extremity orthosis, drop lock retainer, each | 45 | $30.34 |
| L2795 | Addition to lower extremity orthosis, knee control, full kneecap | 45 | $78.79 |
| L2800 | Addition to lower extremity orthosis, knee control, knee cap, medial or lateral pull, for use with custom fabricated orthosis only | 44 | $96.86 |
| L2810 | Addition to lower extremity orthosis, knee control, condylar pad | 45 | $74.28 |
| L2820 | Addition to lower extremity orthosis, soft interface for molded plastic, below knee section | 44 | $83.37 |
| L2830 | Addition to lower extremity orthosis, soft interface for molded plastic, above knee section | 45 | $88.64 |
| L2840 | Addition to lower extremity orthosis, tibial length sock, fracture or equal, each | 43 | $40.65 |
| L2850 | Addition to lower extremity orthosis, femoral length sock, fracture or equal, each | 42 | $57.20 |
| L2861 | Addition to lower extremity joint, knee or ankle, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each | 10 | $262.34 |
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Descriptions are ProviderSignal's own plain-language labels or public-domain CMS text.