L1810 — Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
HCPCS Level II L-code · short descriptor: “Ko elastic with joints”
- 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.
L1810 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $113.17 to $166.75 depending on state and rural status.
Former-CBA payment limits: ceiling $150.89 · floor $113.17
| State | Non-rural | Rural |
|---|---|---|
| AK | $155.87 | — |
| AL | $149.59 | — |
| AR | $122.90 | — |
| AZ | $149.29 | — |
| CA | $149.29 | — |
| CO | $116.04 | — |
| CT | $118.79 | — |
| DC | $113.17 | — |
| DE | $113.17 | — |
| FL | $149.59 | — |
| GA | $149.59 | — |
| HI | $166.75 | — |
| IA | $115.02 | — |
| ID | $131.01 | — |
| IL | $126.52 | — |
| IN | $126.52 | — |
| KS | $115.02 | — |
| KY | $149.59 | — |
| LA | $122.90 | — |
| MA | $118.79 | — |
| MD | $113.17 | — |
| ME | $118.79 | — |
| MI | $126.52 | — |
| MN | $126.52 | — |
| MO | $115.02 | — |
| MS | $149.59 | — |
| MT | $116.04 | — |
| NC | $149.59 | — |
| ND | $116.04 | — |
| NE | $115.02 | — |
| NH | $118.79 | — |
| NJ | $123.44 | — |
| NM | $122.90 | — |
| NV | $149.29 | — |
| NY | $123.44 | — |
| OH | $126.52 | — |
| OK | $122.90 | — |
| OR | $131.01 | — |
| PA | $113.17 | — |
| PR | $135.33 | — |
| RI | $118.79 | — |
| SC | $149.59 | — |
| SD | $116.04 | — |
| TN | $149.59 | — |
| TX | $122.90 | — |
| UT | $116.04 | — |
| VA | $113.17 | — |
| VI | $123.44 | — |
| VT | $118.79 | — |
| WA | $131.01 | — |
| WI | $126.52 | — |
| WV | $113.17 | — |
| WY | $116.04 | — |
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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