MyMedi-AI

L1090 — Addition to ctlso or scoliosis orthosis, lumbar sling

HCPCS Level II L-code · short descriptor: “Lumbar sling”

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.

L1090 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $71.58 to $167.79 depending on state and rural status.

Former-CBA payment limits: ceiling $140.44 · floor $105.33

StateNon-ruralRural
AK$156.93—
AL$105.33—
AR$117.80—
AZ$140.44—
CA$140.44—
CO$113.77—
CT$105.33—
DC$135.96—
DE$135.96—
FL$105.33—
GA$105.33—
HI$167.79—
IA$106.37—
ID$114.21—
IL$123.66—
IN$123.66—
KS$106.37—
KY$105.33—
LA$117.80—
MA$105.33—
MD$135.96—
ME$105.33—
MI$123.66—
MN$123.66—
MO$106.37—
MS$105.33—
MT$113.77—
NC$105.33—
ND$113.77—
NE$106.37—
NH$105.33—
NJ$115.60—
NM$117.80—
NV$140.44—
NY$115.60—
OH$123.66—
OK$117.80—
OR$114.21—
PA$135.96—
PR$71.58—
RI$105.33—
SC$105.33—
SD$113.77—
TN$105.33—
TX$117.80—
UT$113.77—
VA$135.96—
VI$115.60—
VT$105.33—
WA$114.21—
WI$123.66—
WV$135.96—
WY$113.77—
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 L1090 at 1 unit per date of service (clinical). Units above the MUE deny — typically as CO-151. Rationale: Anatomic Consideration.

Common denial codes to watch

Related L-codes

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