High-quality speech coding at low bitrates is crucial for bandwidth-constrained applications, yet remains challenging due to the severe loss of quality-critical information in highly compressed representations. To overcome this challenge, we propose CFMDCTCodec, a low-bitrate neural speech codec that operates entirely in the modified discrete cosine transform (MDCT) domain. CFMDCTCodec integrates a lightweight encoder-quantizer-decoder-style MDCT-spectral codec with a noise-prior-aware, conditional-flow-matching (CFM)-based MDCT-spectral enhancer. Within this framework, the codec serves as a base module that compactly discretizes the MDCT spectrum extracted from speech and produces an initial coarse reconstruction, while the enhancer further restores fine-grained spectral details. The enhancer improves the decoded MDCT spectrum by integrating a conditional MDCT velocity-field filter with an ordinary differential equation (ODE) solver, under the guidance of an MDCT-derived magnitude-adaptive noise prior, aiming to emphasize perceptually significant high-energy regions while stabilizing low-energy and silent regions. Finally, the enhanced MDCT spectrum is reconstructed into the decoded speech using the inverse MDCT. When optimizing CFMDCTCodec, we adopt a unified non-adversarial training strategy that jointly combines reconstruction, quantization and CFM objectives. Both objective and subjective evaluations show that CFMDCTCodec outperforms competitive baselines in low-bitrate regimes, e.g., 0.65 kbps, while approaching the perceptual quality of large-scale codecs with significantly fewer parameters and computations.