MyMedi-AI

L0720 — Cervical-thoracic-lumbar-sacral-orthoses (ctlso), anterior-posterior-lateral control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

HCPCS Level II L-code · short descriptor: “Ctlso a-p-l control custom”

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
Status
Active (April 2026 HCPCS)

Prior authorization

Not on the Medicare required-PA list as of the January 13, 2026 update (74 items). 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 (April 13, 2026 update — 83 items). The standard written order must reach the supplier before claim submission.

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

L0720 Medicare fee schedule (April 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $2220.69 to $2437.98 depending on state and rural status.

StateNon-ruralRural
AK$2332.36
AL$2265.94
AR$2309.48
AZ$2328.63
CA$2328.63
CO$2272.58
CT$2350.67
DC$2220.69
DE$2220.69
FL$2265.94
GA$2265.94
HI$2370.44
IA$2246.69
ID$2266.63
IL$2381.24
IN$2381.24
KS$2246.69
KY$2265.94
LA$2309.48
MA$2350.67
MD$2220.69
ME$2350.67
MI$2381.24
MN$2381.24
MO$2246.69
MS$2265.94
MT$2272.58
NC$2265.94
ND$2272.58
NE$2246.69
NH$2350.67
NJ$2249.02
NM$2309.48
NV$2328.63
NY$2249.02
OH$2381.24
OK$2309.48
OR$2266.63
PA$2220.69
PR$2437.98
RI$2350.67
SC$2265.94
SD$2272.58
TN$2265.94
TX$2309.48
UT$2272.58
VA$2220.69
VI$2427.33
VT$2350.67
WA$2266.63
WI$2381.24
WV$2220.69
WY$2272.58
Amounts are the Medicare DMEPOS fee-schedule allowables effective April 2026. 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.

Common denial codes to watch

Related L-codes

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