L1812 — Knee orthosis, elastic with joints, prefabricated, off-the-shelf
HCPCS Level II L-code · short descriptor: “Ko elastic w/joints pre ots”
- 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.
L1812 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $70.12 to $126.23 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $120.79 | — |
| AL | $85.71 | $117.65 |
| AR | $85.71 | $104.31 |
| AZ | $70.12 | $117.50 |
| CA | $70.12 | $117.50 |
| CO | $71.44 | $100.86 |
| CT | $83.00 | $102.25 |
| DC | $77.63 | $99.44 |
| DE | $77.63 | $99.44 |
| FL | $85.71 | $117.65 |
| GA | $85.71 | $117.65 |
| HI | $126.23 | — |
| IA | $77.34 | $100.36 |
| ID | $71.44 | $108.36 |
| IL | $78.51 | $106.11 |
| IN | $78.51 | $106.11 |
| KS | $77.34 | $100.36 |
| KY | $85.71 | $117.65 |
| LA | $85.71 | $104.31 |
| MA | $83.00 | $102.25 |
| MD | $77.63 | $99.44 |
| ME | $83.00 | $102.25 |
| MI | $78.51 | $106.11 |
| MN | $77.34 | $106.11 |
| MO | $77.34 | $100.36 |
| MS | $85.71 | $117.65 |
| MT | $71.44 | $100.86 |
| NC | $85.71 | $117.65 |
| ND | $77.34 | $100.86 |
| NE | $77.34 | $100.36 |
| NH | $83.00 | $102.25 |
| NJ | $77.63 | $104.58 |
| NM | $70.12 | $104.31 |
| NV | $70.12 | $117.50 |
| NY | $77.63 | $104.58 |
| OH | $78.51 | $106.11 |
| OK | $70.12 | $104.31 |
| OR | $70.12 | $108.36 |
| PA | $77.63 | $99.44 |
| PR | $110.52 | — |
| RI | $83.00 | $102.25 |
| SC | $85.71 | $117.65 |
| SD | $77.34 | $100.86 |
| TN | $85.71 | $117.65 |
| TX | $70.12 | $104.31 |
| UT | $71.44 | $100.86 |
| VA | $85.71 | $99.44 |
| VI | $104.58 | — |
| VT | $83.00 | $102.25 |
| WA | $70.12 | $108.36 |
| WI | $78.51 | $106.11 |
| WV | $85.71 | $99.44 |
| WY | $71.44 | $100.86 |
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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