L4130 — Replace pretibial shell
L4130 is a HCPCS Level II code for replace pretibial shell. It belongs to the Orthotic and Prosthetic Procedures and Devices section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
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 L4130 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.
The CMS record for L4130
- Long descriptor
- Replace pretibial shell
- Short descriptor
- Replace pretibial shell
- Added
- January 1, 1984
- BETOS
- D1F
- Pricing indicator
- 38 — DMEPOS
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Orthotics, prosthetics, prosthetic devices and vision services. Price subject to floors and ceilings.
Codes adjacent to L4130
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If L4130 is not quite right, the correct code is very often within a few positions of it.
- L4050Replace molded calf lacer, for custom fabricated orthosis only
- L4055Replace non-molded calf lacer, for custom fabricated orthosis only
- L4060Replace high roll cuff
- L4070Replace proximal and distal upright for kafo
- L4080Replace metal bands kafo, proximal thigh
- L4090Replace metal bands kafo-afo, calf or distal thigh
- L4100Replace leather cuff kafo, proximal thigh
- L4110Replace leather cuff kafo-afo, calf or distal thigh
- L4205Repair of orthotic device, labor component, per 15 minutes
- L4210Repair of orthotic device, repair or replace minor parts
- L4350Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf
- L4360Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
- L4361Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf
- L4370Pneumatic full leg splint, prefabricated, off-the-shelf
- L4386Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
- L4387Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf
Questions about L4130
What is HCPCS code L4130?
L4130 is a HCPCS Level II code for replace pretibial shell. It sits in the Orthotic and Prosthetic Procedures and Devices section.
Does Medicare cover L4130?
The CMS HCPCS file marks L4130 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.