MyMedi-AI

L1230 — Addition to tlso, (low profile), milwaukee type superstructure

HCPCS Level II L-code · short descriptor: “Milwaukee type superstructur”

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.

L1230 Medicare fee schedule (April 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $653.22 to $1144.60 depending on state and rural status.

Former-CBA payment limits: ceiling $870.95 · floor $653.22

StateNon-ruralRural
AK$658.22
AL$653.22
AR$653.22
AZ$682.06
CA$682.06
CO$868.28
CT$734.50
DC$736.27
DE$736.27
FL$653.22
GA$653.22
HI$703.85
IA$653.22
ID$653.22
IL$819.86
IN$819.86
KS$653.22
KY$653.22
LA$653.22
MA$734.50
MD$736.27
ME$734.50
MI$819.86
MN$819.86
MO$653.22
MS$653.22
MT$868.28
NC$653.22
ND$868.28
NE$653.22
NH$734.50
NJ$870.95
NM$653.22
NV$682.06
NY$870.95
OH$819.86
OK$653.22
OR$653.22
PA$736.27
PR$1144.60
RI$734.50
SC$653.22
SD$868.28
TN$653.22
TX$653.22
UT$868.28
VA$736.27
VI$870.95
VT$734.50
WA$653.22
WI$819.86
WV$736.27
WY$868.28
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 L1230 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, L1230 included, and starter credits via POST /bot-marketplace/register.