MyMedi-AI

L0160 — Cervical, semi-rigid, wire frame occipital/mandibular support, prefabricated, off-the-shelf

HCPCS Level II L-code · short descriptor: “Cerv sr wire occ/man pre ots”

Code system
HCPCS Level II
Family
L — Orthotics & prosthetics
Medicare coverage status
Carrier judgment — coverage decided by the DME MAC
DMEPOS payment category
Prosthetics & orthotics
Prior authorization
Not on Medicare required-PA list
Face-to-face & WOPD
Not on the required list
MUE unit limit
1
Status
Active (HCPCS Level II October 2026)

Prior authorization

Not on the Medicare required-PA list (CMS Required Prior Authorization List — 74 items in force on 2026-10-25; 8 more from 2026-10-28; sources: CMS list updated 2026-01-13, CMS-6109-N (91 FR 47972)). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.

Order readiness — what the written order must contain

Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):

  • Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
  • General description of the item (42 CFR 410.38(d)(1)(i)(B))
  • Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
  • Order date (42 CFR 410.38(d)(1)(i)(D))
  • Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
  • Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))

Not on the F2F/WOPD list (CMS Required F2F & WOPD List — 83 items in force on 2026-10-25; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). The standard written order must reach the supplier before claim submission.

Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.

L0160 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $179.98 to $239.97 depending on state and rural status.

Former-CBA payment limits: ceiling $239.97 · floor $179.98

StateNon-ruralRural
AK$204.46—
AL$204.81—
AR$239.97—
AZ$203.13—
CA$203.13—
CO$179.98—
CT$239.97—
DC$179.98—
DE$179.98—
FL$204.81—
GA$204.81—
HI$218.68—
IA$200.13—
ID$179.98—
IL$192.08—
IN$192.08—
KS$200.13—
KY$204.81—
LA$239.97—
MA$239.97—
MD$179.98—
ME$239.97—
MI$192.08—
MN$192.08—
MO$200.13—
MS$204.81—
MT$179.98—
NC$204.81—
ND$179.98—
NE$200.13—
NH$239.97—
NJ$192.56—
NM$239.97—
NV$203.13—
NY$192.56—
OH$192.08—
OK$239.97—
OR$179.98—
PA$179.98—
PR$182.74—
RI$239.97—
SC$204.81—
SD$179.98—
TN$204.81—
TX$239.97—
UT$179.98—
VA$179.98—
VI$192.56—
VT$239.97—
WA$179.98—
WI$192.08—
WV$179.98—
WY$179.98—
Amounts are the Medicare DMEPOS fee-schedule allowables effective October 2026 (CMS DMEPOS Fee Schedule October 2026 (DME26-D)). Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%. A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area adjustments and non-continental rates can differ — verify with your DME MAC.

Unit limit (MUE)

Medicare's Medically Unlikely Edit caps L0160 at 1 unit per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: Anatomic Consideration.

Common denial codes to watch

Related L-codes

Bill L0160 with confidence

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