New HCPCS Code as of 10.1.26

CMS just announced a new HCPCS code that will provide lower extremity specialists to offer an off-the-shelf version of a custom-fitted hinged ankle brace.

The new code L1972, is defined exactly as L1971: “ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL WITH ANKLE JOINT, WITH OR WITHOUT DORSIFLEXION ASSIST, PREFABRICATED”. Notice, however, that L1972 is absent of any reference to bent-molded, assembled, or otherwise—which is the last part of the L1971 code that does specify customization to a specific patient by an individual with expertise. Reimbursement for both L1971 and L1972, by statute, will be the same.

As of October 15, 2026, CMS announced that L1971 and others will be subject to a 12-month prior approval process for certain HCPCS codes. The prior approval period starts with their initial claim for any of the specific codes listed. Whether or not L1972 will be subject to this same prior approval process is a question posed to the
PDAC. For more information on this, visit www.cms.gov/data-research/monitoring-programs/medicare-fee-service-compliance-programs/prior-authorization-pre-claim-review-initiatives/probationary-prior-authorization-process-newly-enrolled-suppliers-certain-durable-medical-equipment.

Also posed to the PDAC was whether products already validated as L1971 will automatically have an additional validation of L1972 added to their product listing, or whether those products will require a new application. Certainly any future products validated as L1971/ L1972 will need to have supporting documentation of a custom fit possibility in addition to OTS fitting in order to receive dual code designation. According to a 10.1.2026 conversation with the PDAC medical director, he is awaiting more clarification from CMS. Stay tuned for updates on this matter.

—Paul Kesselman, DPM