MyMedi-AI

L1300 — Other scoliosis procedure, body jacket molded to patient model

HCPCS Level II L-code · short descriptor: “Body jacket mold to patient”

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 2026-10-26; 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 2026-10-26; 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.

L1300 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $1919.53 to $3013.95 depending on state and rural status.

Former-CBA payment limits: ceiling $2559.37 · floor $1919.53

StateNon-ruralRural
AK$2818.56—
AL$1919.53—
AR$2212.58—
AZ$2559.37—
CA$2559.37—
CO$2385.46—
CT$2041.90—
DC$2116.61—
DE$2116.61—
FL$1919.53—
GA$1919.53—
HI$3013.95—
IA$2066.79—
ID$1941.17—
IL$2118.07—
IN$2118.07—
KS$2066.79—
KY$1919.53—
LA$2212.58—
MA$2041.90—
MD$2116.61—
ME$2041.90—
MI$2118.07—
MN$2118.07—
MO$2066.79—
MS$1919.53—
MT$2385.46—
NC$1919.53—
ND$2385.46—
NE$2066.79—
NH$2041.90—
NJ$2559.37—
NM$2212.58—
NV$2559.37—
NY$2559.37—
OH$2118.07—
OK$2212.58—
OR$1941.17—
PA$2116.61—
PR$2807.76—
RI$2041.90—
SC$1919.53—
SD$2385.46—
TN$1919.53—
TX$2212.58—
UT$2385.46—
VA$2116.61—
VI$2559.37—
VT$2041.90—
WA$1941.17—
WI$2118.07—
WV$2116.61—
WY$2385.46—
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 L1300 at 1 unit per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: Anatomic Consideration.

Common denial codes to watch

Related L-codes

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