MyMedi-AI

L1005 — Tension based scoliosis orthosis and accessory pads, includes fitting and adjustment

HCPCS Level II L-code · short descriptor: “Tension based scoliosis orth”

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.

L1005 Medicare fee schedule (April 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $3839.20 to $4223.13 depending on state and rural status.

Former-CBA payment limits: ceiling $4685.17 · floor $3513.88

StateNon-ruralRural
AK$3839.20
AL$3954.81
AR$3954.38
AZ$3839.20
CA$3839.20
CO$3976.59
CT$3839.20
DC$3839.20
DE$3839.20
FL$3954.81
GA$3954.81
HI$3839.20
IA$3914.12
ID$3839.20
IL$3933.46
IN$3933.46
KS$3914.12
KY$3954.81
LA$3954.38
MA$3839.20
MD$3839.20
ME$3839.20
MI$3933.46
MN$3933.46
MO$3914.12
MS$3954.81
MT$3976.59
NC$3954.81
ND$3976.59
NE$3914.12
NH$3839.20
NJ$3839.20
NM$3954.38
NV$3839.20
NY$3839.20
OH$3933.46
OK$3954.38
OR$3839.20
PA$3839.20
PR$4223.13
RI$3839.20
SC$3954.81
SD$3976.59
TN$3954.81
TX$3954.38
UT$3976.59
VA$3839.20
VI$4223.13
VT$3839.20
WA$3839.20
WI$3933.46
WV$3839.20
WY$3976.59
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

Bill L1005 with confidence

MyMedi-AI scrubs whole claims against NCCI pairs, MUE limits, modifier rules, and PA flags before you submit — built for DME teams, no PHI stored on our servers.

Start free trial   Run a CMS-0057-F readiness check

Prefer DIY compliance? Self-audit documentation kits for DME suppliers →

Building an AI agent? Try the agent API in the playground — free PA-required lookups, L1005 included, and starter credits via POST /bot-marketplace/register.