HCPCS Level II · Orthotic and prosthetic procedures and devices
L1904Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated
✓ Active
Source: CMS HCPCS quarterly update, October 2026. Page updated September 29, 2026.
About L1904
L1904 is an HCPCS Level II code in the L series (orthotic and prosthetic procedures and devices), describing ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated.
It was added to HCPCS effective 01/01/1988, and its current record took effect 01/01/2016.
Its Medicare coverage code is "C", meaning coverage is left to the Medicare contractor's judgment.
Details
- Short description
- Afo molded ankle gauntlet
- Date added
- 01/01/1988
- Action effective
- 01/01/2016
- BETOS
- D1F
Related L19xx codes
- L1900Ankle foot orthosis, spring wire, dorsiflexion assist calf band, custom fabricated
- L1902Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf
- L1906Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf
- L1907Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated
- L1910Ankle foot orthosis, posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment
- L1920Ankle foot orthosis, single upright with static or adjustable stop (phelps or perlstein type), custom fabricated
- L1930Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment
- L1932Ankle foot orthosis, rigid anterior tibial section, total carbon fiber or equal material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
- L1933Ankle foot orthosis, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, off-the-shelf
- L1940Ankle foot orthosis, plastic or other material, custom fabricated
- L1945Ankle foot orthosis, plastic, rigid anterior tibial section (floor reaction), custom fabricated
- L1950Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic, custom fabricated
Common questions about L1904
Is HCPCS L1904 still valid?
- Yes. L1904 is active in the CMS October 2026 HCPCS file.
Does Medicare cover L1904?
- Its coverage code is "C": coverage is left to the Medicare contractor's judgment. Check the local coverage determination for your region.