# HCPCS L1902: Ankle orthosis, ankle gauntlet, prefabricated

Medicare HCPCS L1902 pays $102.92 on average under the 2026 Q4 Medicare DMEPOS Fee Schedule (non-rural). State amounts run from $85.68 in Puerto Rico to $122.31 in Arkansas, a 43% spread.

Web page: https://www.med-reveal.com/rates/L1902-hcpcs-fee-schedule
Section: DME, Prosthetics, Orthotics and Supplies

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $102.92 |
| National facility | $102.92 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Arkansas | $122.31 | $122.31 |
| Louisiana | $122.31 | $122.31 |
| New Mexico | $122.31 | $122.31 |
| Oklahoma | $122.31 | $122.31 |
| Texas | $122.31 | $122.31 |
| New Jersey | $120.04 | $120.04 |
| New York | $120.04 | $120.04 |
| Virgin Islands | $120.02 | $120.02 |
| Hawaii | $116.17 | $116.17 |
| Idaho | $112.48 | $112.48 |
| Oregon | $112.48 | $112.48 |
| Washington | $112.48 | $112.48 |
| Alaska | $108.65 | $108.65 |
| Delaware | $107.12 | $107.12 |
| District of Columbia | $107.12 | $107.12 |
| Maryland | $107.12 | $107.12 |
| Pennsylvania | $107.12 | $107.12 |
| Virginia | $107.12 | $107.12 |
| West Virginia | $107.12 | $107.12 |
| Connecticut | $105.66 | $105.66 |
| Maine | $105.66 | $105.66 |
| Massachusetts | $105.66 | $105.66 |
| New Hampshire | $105.66 | $105.66 |
| Rhode Island | $105.66 | $105.66 |
| Vermont | $105.66 | $105.66 |
| Arizona | $105.11 | $105.11 |
| California | $105.11 | $105.11 |
| Nevada | $105.11 | $105.11 |
| Iowa | $96.81 | $96.81 |
| Kansas | $96.81 | $96.81 |
| Missouri | $96.81 | $96.81 |
| Nebraska | $96.81 | $96.81 |
| Alabama | $94.39 | $94.39 |
| Florida | $94.39 | $94.39 |
| Georgia | $94.39 | $94.39 |
| Kentucky | $94.39 | $94.39 |
| Mississippi | $94.39 | $94.39 |
| North Carolina | $94.39 | $94.39 |
| South Carolina | $94.39 | $94.39 |
| Tennessee | $94.39 | $94.39 |
| Colorado | $91.73 | $91.73 |
| Illinois | $91.73 | $91.73 |
| Indiana | $91.73 | $91.73 |
| Michigan | $91.73 | $91.73 |
| Minnesota | $91.73 | $91.73 |
| Montana | $91.73 | $91.73 |
| North Dakota | $91.73 | $91.73 |
| Ohio | $91.73 | $91.73 |
| South Dakota | $91.73 | $91.73 |
| Utah | $91.73 | $91.73 |
| Wisconsin | $91.73 | $91.73 |
| Wyoming | $91.73 | $91.73 |
| Puerto Rico | $85.68 | $85.68 |

## Related codes

- L0112: Cranial cervical orthosis, congenital torticollis type — https://www.med-reveal.com/rates/L0112-hcpcs-fee-schedule
- L0140: Cervical, semi-rigid, thermoplastic collar, molded to patient — https://www.med-reveal.com/rates/L0140-hcpcs-fee-schedule
- L0450: Thoracic-lumbar-sacral orthosis (TLSO), flexible, provides trunk support — https://www.med-reveal.com/rates/L0450-hcpcs-fee-schedule
- L0500: Thoracic-lumbar-sacral orthosis (TLSO), rigid, custom fitted — https://www.med-reveal.com/rates/L0500-hcpcs-fee-schedule
- L0621: Sacroiliac orthosis, flexible, provides pelvic-sacral support — https://www.med-reveal.com/rates/L0621-hcpcs-fee-schedule
- L0630: Lumbar-sacral orthosis, sagittal control, rigid posterior panel — https://www.med-reveal.com/rates/L0630-hcpcs-fee-schedule
- L0810: Addition to halo procedure, cervical collar with attachment — https://www.med-reveal.com/rates/L0810-hcpcs-fee-schedule
- L1000: Cervical-thoracic-lumbar-sacral orthosis, anterior-posterior-lateral control — https://www.med-reveal.com/rates/L1000-hcpcs-fee-schedule

Commercial negotiated rates for L1902 by payer and state: https://www.med-reveal.com/solutions/rate-benchmarking

## Sources

- CMS Medicare fee schedules (2026 Q4): https://www.cms.gov/medicare/payment/fee-schedules