L1845 — Knee orthosis, double 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 double 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 L1845 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.
L1845 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $939.24 to $1180.51 depending on state and rural status.
Former-CBA payment limits: ceiling $1252.32 · floor $939.24
| State | Non-rural | Rural |
|---|---|---|
| AK | $960.18 | — |
| AL | $1157.34 | — |
| AR | $1076.32 | — |
| AZ | $939.24 | — |
| CA | $939.24 | — |
| CO | $970.06 | — |
| CT | $1000.77 | — |
| DC | $1116.88 | — |
| DE | $1116.88 | — |
| FL | $1157.34 | — |
| GA | $1157.34 | — |
| HI | $1026.74 | — |
| IA | $939.24 | — |
| ID | $975.43 | — |
| IL | $1029.48 | — |
| IN | $1029.48 | — |
| KS | $939.24 | — |
| KY | $1157.34 | — |
| LA | $1076.32 | — |
| MA | $1000.77 | — |
| MD | $1116.88 | — |
| ME | $1000.77 | — |
| MI | $1029.48 | — |
| MN | $1029.48 | — |
| MO | $939.24 | — |
| MS | $1157.34 | — |
| MT | $970.06 | — |
| NC | $1157.34 | — |
| ND | $970.06 | — |
| NE | $939.24 | — |
| NH | $1000.77 | — |
| NJ | $1180.50 | — |
| NM | $1076.32 | — |
| NV | $939.24 | — |
| NY | $1180.50 | — |
| OH | $1029.48 | — |
| OK | $1076.32 | — |
| OR | $975.43 | — |
| PA | $1116.88 | — |
| PR | $1104.09 | — |
| RI | $1000.77 | — |
| SC | $1157.34 | — |
| SD | $970.06 | — |
| TN | $1157.34 | — |
| TX | $1076.32 | — |
| UT | $970.06 | — |
| VA | $1116.88 | — |
| VI | $1180.51 | — |
| VT | $1000.77 | — |
| WA | $975.43 | — |
| WI | $1029.48 | — |
| WV | $1116.88 | — |
| WY | $970.06 | — |
Common denial codes to watch
Related L-codes
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