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L1844 — 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, custom fabricated

HCPCS Level II L-code · short descriptor: “Ko w/adj jt rot cntrl molded” · 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 2026-04-13)
Face-to-face & WOPD
Not on the required list
MUE unit limit
2
Status
Active (HCPCS Level II October 2026)

Prior authorization

PA REQUIRED L1844 is on Medicare's DMEPOS Required Prior Authorization List (Orthoses — nationwide since 2026-04-13).

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))

Not on the F2F/WOPD list (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)). The standard written order must reach the supplier before claim submission.

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

L1844 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $1865.51 to $2436.24 depending on state and rural status.

Former-CBA payment limits: ceiling $2436.24 · floor $1827.18

StateNon-ruralRural
AK$2160.99—
AL$1921.07—
AR$1917.72—
AZ$2436.24—
CA$2436.24—
CO$2062.64—
CT$1962.60—
DC$1865.51—
DE$1865.51—
FL$1921.07—
GA$1921.07—
HI$2160.99—
IA$2312.28—
ID$2417.67—
IL$1871.51—
IN$1871.51—
KS$2312.28—
KY$1921.07—
LA$1917.72—
MA$1962.60—
MD$1865.51—
ME$1962.60—
MI$1871.51—
MN$1871.51—
MO$2312.28—
MS$1921.07—
MT$2062.64—
NC$1921.07—
ND$2062.64—
NE$2312.28—
NH$1962.60—
NJ$1878.84—
NM$1917.72—
NV$2436.24—
NY$1878.84—
OH$1871.51—
OK$1917.72—
OR$2417.67—
PA$1865.51—
PR$2237.92—
RI$1962.60—
SC$1921.07—
SD$2062.64—
TN$1921.07—
TX$1917.72—
UT$2062.64—
VA$1865.51—
VI$1878.84—
VT$1962.60—
WA$2417.67—
WI$1871.51—
WV$1865.51—
WY$2062.64—
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 L1844 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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