MyMedi-AI

L1120 — Addition to ctlso, scoliosis orthosis, cover for upright, each

HCPCS Level II L-code · short descriptor: “Covers for upright each”

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
3
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.

L1120 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $28.75 to $114.51 depending on state and rural status.

Former-CBA payment limits: ceiling $60.85 · floor $45.64

StateNon-ruralRural
AK$107.10—
AL$50.16—
AR$53.66—
AZ$60.85—
CA$60.85—
CO$49.35—
CT$45.64—
DC$49.63—
DE$49.63—
FL$50.16—
GA$50.16—
HI$114.51—
IA$45.64—
ID$56.49—
IL$46.74—
IN$46.74—
KS$45.64—
KY$50.16—
LA$53.66—
MA$45.64—
MD$49.63—
ME$45.64—
MI$46.74—
MN$46.74—
MO$45.64—
MS$50.16—
MT$49.35—
NC$50.16—
ND$49.35—
NE$45.64—
NH$45.64—
NJ$45.64—
NM$53.66—
NV$60.85—
NY$45.64—
OH$46.74—
OK$53.66—
OR$56.49—
PA$49.63—
PR$28.75—
RI$45.64—
SC$50.16—
SD$49.35—
TN$50.16—
TX$53.66—
UT$49.35—
VA$49.63—
VI$45.64—
VT$45.64—
WA$56.49—
WI$46.74—
WV$49.63—
WY$49.35—
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 L1120 at 3 units per date of service (clinical). Units above the MUE deny — typically as CO-151. Rationale: Nature of Equipment.

Common denial codes to watch

Related L-codes

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