L1843 — Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, 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 single upright pre cst” · PA required
- 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 (Medicare, since 2024-08-12)
- Status
- Active (April 2026 HCPCS)
Prior authorization
PA REQUIRED L1843 is on Medicare's DMEPOS Required Prior Authorization List (Orthoses — nationwide since 2024-08-12).
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.
L1843 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $1076.26 to $1183.90 depending on state and rural status.
Former-CBA payment limits: ceiling $1313.43 · floor $985.07
| State | Non-rural | Rural |
|---|---|---|
| AK | $1076.26 | — |
| AL | $1108.66 | — |
| AR | $1108.58 | — |
| AZ | $1076.26 | — |
| CA | $1076.26 | — |
| CO | $1114.82 | — |
| CT | $1076.26 | — |
| DC | $1076.26 | — |
| DE | $1076.26 | — |
| FL | $1108.66 | — |
| GA | $1108.66 | — |
| HI | $1076.26 | — |
| IA | $1097.30 | — |
| ID | $1076.26 | — |
| IL | $1102.71 | — |
| IN | $1102.71 | — |
| KS | $1097.30 | — |
| KY | $1108.66 | — |
| LA | $1108.58 | — |
| MA | $1076.26 | — |
| MD | $1076.26 | — |
| ME | $1076.26 | — |
| MI | $1102.71 | — |
| MN | $1102.71 | — |
| MO | $1097.30 | — |
| MS | $1108.66 | — |
| MT | $1114.82 | — |
| NC | $1108.66 | — |
| ND | $1114.82 | — |
| NE | $1097.30 | — |
| NH | $1076.26 | — |
| NJ | $1076.26 | — |
| NM | $1108.58 | — |
| NV | $1076.26 | — |
| NY | $1076.26 | — |
| OH | $1102.71 | — |
| OK | $1108.58 | — |
| OR | $1076.26 | — |
| PA | $1076.26 | — |
| PR | $1183.90 | — |
| RI | $1076.26 | — |
| SC | $1108.66 | — |
| SD | $1114.82 | — |
| TN | $1108.66 | — |
| TX | $1108.58 | — |
| UT | $1114.82 | — |
| VA | $1076.26 | — |
| VI | $1183.90 | — |
| VT | $1076.26 | — |
| WA | $1076.26 | — |
| WI | $1102.71 | — |
| WV | $1076.26 | — |
| WY | $1114.82 | — |
Common denial codes to watch
Related L-codes
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