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
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.

L1300 Medicare fee schedule (April 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 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

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