MyMedi-AI

L1310 — Other scoliosis procedure, post-operative body jacket

HCPCS Level II L-code · short descriptor: “Post-operative body jacket”

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.

L1310 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $1975.19 to $2631.87 depending on state and rural status.

Former-CBA payment limits: ceiling $2633.59 · floor $1975.19

StateNon-ruralRural
AK$2461.31—
AL$1975.19—
AR$2131.40—
AZ$2405.14—
CA$2405.14—
CO$2526.04—
CT$2197.59—
DC$2174.83—
DE$2174.83—
FL$1975.19—
GA$1975.19—
HI$2631.87—
IA$2202.99—
ID$2174.28—
IL$2206.15—
IN$2206.15—
KS$2202.99—
KY$1975.19—
LA$2131.40—
MA$2197.59—
MD$2174.83—
ME$2197.59—
MI$2206.15—
MN$2206.15—
MO$2202.99—
MS$1975.19—
MT$2526.04—
NC$1975.19—
ND$2526.04—
NE$2202.99—
NH$2197.59—
NJ$2549.09—
NM$2131.40—
NV$2405.14—
NY$2549.09—
OH$2206.15—
OK$2131.40—
OR$2174.28—
PA$2174.83—
PR$2249.52—
RI$2197.59—
SC$1975.19—
SD$2526.04—
TN$1975.19—
TX$2131.40—
UT$2526.04—
VA$2174.83—
VI$2549.10—
VT$2197.59—
WA$2174.28—
WI$2206.15—
WV$2174.83—
WY$2526.04—
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 L1310 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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