Fidelis includes HCPCS L3000 (Foot, insert, removable, molded to patient model, 'UCB' type, Berkeley Shell, each) on its list of DME products for which authorization is required.  That list is here:  https://www.fideliscare.org/Portals/0/Providers/AuthorizationGrids/2020-01-FidelisCare-Medicaid-DME-AuthorizationGrid-English.pdf

Fidelis lists its Durable Medical Equipment and Orthotics and Prosthetics Guidelines here:  https://www.fideliscare.org/Portals/0/Providers/CP.FC.06-DME-Orthotics-and-Prosthetics.pdf

Fidelis does not list any specifics regarding coverage of the product represented by L3000.  In the absence of a specific listing of coverage requirements, coverage is typically dependent on the documentation establishing the medical necessity of the service.