L3430 — Heel, counter, plastic reinforced

Medicare coverage: Special coverage instructions apply

There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.

From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.

Medically Unlikely Edits — units per day

The most units of L3430 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.

practitioner

0 — never payable

MAI 3 — Date of Service Edit: Clinical · CMS Policy

outpatient

2 units

MAI 2 — Date of Service Edit: Policy · Anatomic Consideration

DME supplier

2 units

MAI 2 — Date of Service Edit: Policy · Anatomic Consideration

The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.