L1833 — Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf
HCPCS Level II L-code · short descriptor: “Ko adj jnt pos r sup 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
- Required from 2026-10-28 (Medicare)
- Face-to-face & WOPD
- Required from 2026-10-28 (Orthoses)
- MUE unit limit
- 2
- Status
- Active (HCPCS Level II October 2026)
Prior authorization
PA STARTS 2026-10-28 L1833 joins Medicare's DMEPOS Required Prior Authorization List for dates of service on or after 2026-10-28 (Orthoses — CMS-6109-N, 91 FR 47972 (published 2026-07-30)).
Claims for this item without an affirmed prior-authorization decision are automatically denied (commonly surfacing as CO-197). Submit the PA request to your DME MAC with the order and supporting clinical documentation 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))
F2F + WOPD FROM 2026-10-28 L1833 joins Medicare's Required Face-to-Face & WOPD List for dates of service on or after 2026-10-28 (Orthoses — CMS-6109-N, 91 FR 47972 (published 2026-07-30)). From that date two extra conditions of payment apply:
- Face-to-face encounter (in-person or telehealth) with the treating practitioner within the 6 months before the order date
- Written order communicated to the supplier before delivery (WOPD)
Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.
L1833 Medicare fee schedule (October 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $455.16 to $1087.16 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $685.69 | — |
| AL | $556.31 | $743.90 |
| AR | $556.31 | $627.47 |
| AZ | $455.16 | $695.27 |
| CA | $455.16 | $695.27 |
| CO | $463.72 | $627.47 |
| CT | $538.74 | $734.24 |
| DC | $503.87 | $684.50 |
| DE | $503.87 | $684.50 |
| FL | $556.31 | $743.90 |
| GA | $556.31 | $743.90 |
| HI | $713.94 | — |
| IA | $502.02 | $627.47 |
| ID | $463.72 | $627.47 |
| IL | $509.63 | $701.41 |
| IN | $509.63 | $701.41 |
| KS | $502.02 | $627.47 |
| KY | $556.31 | $743.90 |
| LA | $556.31 | $627.47 |
| MA | $538.74 | $734.24 |
| MD | $503.87 | $684.50 |
| ME | $538.74 | $734.24 |
| MI | $509.63 | $701.41 |
| MN | $502.02 | $701.41 |
| MO | $502.02 | $627.47 |
| MS | $556.31 | $743.90 |
| MT | $463.72 | $627.47 |
| NC | $556.31 | $743.90 |
| ND | $502.02 | $627.47 |
| NE | $502.02 | $627.47 |
| NH | $538.74 | $734.24 |
| NJ | $503.87 | $743.90 |
| NM | $455.16 | $627.47 |
| NV | $455.16 | $695.27 |
| NY | $503.87 | $743.90 |
| OH | $509.63 | $701.41 |
| OK | $455.16 | $627.47 |
| OR | $455.16 | $627.47 |
| PA | $503.87 | $684.50 |
| PR | $1087.16 | — |
| RI | $538.74 | $734.24 |
| SC | $556.31 | $743.90 |
| SD | $502.02 | $627.47 |
| TN | $556.31 | $743.90 |
| TX | $455.16 | $627.47 |
| UT | $463.72 | $627.47 |
| VA | $556.31 | $684.50 |
| VI | $743.90 | — |
| VT | $538.74 | $734.24 |
| WA | $455.16 | $627.47 |
| WI | $509.63 | $701.41 |
| WV | $556.31 | $684.50 |
| WY | $463.72 | $627.47 |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps L1833 at 2 units 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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