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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
Not on Medicare required-PA list
Face-to-face & WOPD
Not on the required 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.

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))

Not on the F2F/WOPD list (April 13, 2026 update — 83 items). The standard written order must reach the supplier before claim submission.

Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.

L1833 Medicare fee schedule (April 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $455.16 to $1087.16 depending on state and rural status.

StateNon-ruralRural
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
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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