MyMedi-AI

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)
Face-to-face & WOPD
Required (Orthoses)
MUE unit limit
2
Status
Active (HCPCS Level II October 2026)

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.

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 REQUIRED L1843 is on Medicare's Required Face-to-Face & WOPD List (Orthoses — CMS Required F2F & WOPD List — 83 items in force on 2026-10-25; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). 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.

L1843 Medicare fee schedule (October 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

StateNon-ruralRural
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—
Amounts are the Medicare DMEPOS fee-schedule allowables effective October 2026 (CMS DMEPOS Fee Schedule October 2026 (DME26-D)). 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.

Unit limit (MUE)

Medicare's Medically Unlikely Edit caps L1843 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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