L1630 — Hip orthosis, abduction control of hip joints, semi-flexible (von rosen type), custom fabricated
HCPCS Level II L-code · short descriptor: “Abduct control hip semi-flex”
- 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
- 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.
L1630 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $170.36 to $259.63 depending on state and rural status.
Former-CBA payment limits: ceiling $259.63 · floor $194.72
| State | Non-rural | Rural |
|---|---|---|
| AK | $213.12 | — |
| AL | $198.25 | — |
| AR | $194.72 | — |
| AZ | $211.83 | — |
| CA | $211.83 | — |
| CO | $194.72 | — |
| CT | $259.63 | — |
| DC | $194.72 | — |
| DE | $194.72 | — |
| FL | $198.25 | — |
| GA | $198.25 | — |
| HI | $227.90 | — |
| IA | $213.18 | — |
| ID | $210.31 | — |
| IL | $259.63 | — |
| IN | $259.63 | — |
| KS | $213.18 | — |
| KY | $198.25 | — |
| LA | $194.72 | — |
| MA | $259.63 | — |
| MD | $194.72 | — |
| ME | $259.63 | — |
| MI | $259.63 | — |
| MN | $259.63 | — |
| MO | $213.18 | — |
| MS | $198.25 | — |
| MT | $194.72 | — |
| NC | $198.25 | — |
| ND | $194.72 | — |
| NE | $213.18 | — |
| NH | $259.63 | — |
| NJ | $194.72 | — |
| NM | $194.72 | — |
| NV | $211.83 | — |
| NY | $194.72 | — |
| OH | $259.63 | — |
| OK | $194.72 | — |
| OR | $210.31 | — |
| PA | $194.72 | — |
| PR | $170.36 | — |
| RI | $259.63 | — |
| SC | $198.25 | — |
| SD | $194.72 | — |
| TN | $198.25 | — |
| TX | $194.72 | — |
| UT | $194.72 | — |
| VA | $194.72 | — |
| VI | $194.72 | — |
| VT | $259.63 | — |
| WA | $210.31 | — |
| WI | $259.63 | — |
| WV | $194.72 | — |
| WY | $194.72 | — |
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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