L1820 — Knee orthosis, elastic with condylar pads and joints, with or without patellar control, 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 elas w/ condyle pads & jo”
- 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.
L1820 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $148.99 to $194.23 depending on state and rural status.
Former-CBA payment limits: ceiling $198.66 · floor $148.99
| State | Non-rural | Rural |
|---|---|---|
| AK | $181.64 | — |
| AL | $148.99 | — |
| AR | $165.33 | — |
| AZ | $181.78 | — |
| CA | $181.78 | — |
| CO | $162.95 | — |
| CT | $174.92 | — |
| DC | $175.32 | — |
| DE | $175.32 | — |
| FL | $148.99 | — |
| GA | $148.99 | — |
| HI | $194.23 | — |
| IA | $152.53 | — |
| ID | $165.77 | — |
| IL | $174.65 | — |
| IN | $174.65 | — |
| KS | $152.53 | — |
| KY | $148.99 | — |
| LA | $165.33 | — |
| MA | $174.92 | — |
| MD | $175.32 | — |
| ME | $174.92 | — |
| MI | $174.65 | — |
| MN | $174.65 | — |
| MO | $152.53 | — |
| MS | $148.99 | — |
| MT | $162.95 | — |
| NC | $148.99 | — |
| ND | $162.95 | — |
| NE | $152.53 | — |
| NH | $174.92 | — |
| NJ | $169.15 | — |
| NM | $165.33 | — |
| NV | $181.78 | — |
| NY | $169.15 | — |
| OH | $174.65 | — |
| OK | $165.33 | — |
| OR | $165.77 | — |
| PA | $175.32 | — |
| PR | $173.77 | — |
| RI | $174.92 | — |
| SC | $148.99 | — |
| SD | $162.95 | — |
| TN | $148.99 | — |
| TX | $165.33 | — |
| UT | $162.95 | — |
| VA | $175.32 | — |
| VI | $169.15 | — |
| VT | $174.92 | — |
| WA | $165.77 | — |
| WI | $174.65 | — |
| WV | $175.32 | — |
| WY | $162.95 | — |
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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