MyMedi-AI

L1846 — 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, custom fabricated

HCPCS Level II L-code · short descriptor: “Ko w adj flex/ext rotat mold” · 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 L1846 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.

L1846 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $1283.72 to $1960.17 depending on state and rural status.

Former-CBA payment limits: ceiling $1711.62 · floor $1283.72

StateNon-ruralRural
AK$1833.15—
AL$1468.46—
AR$1348.79—
AZ$1711.62—
CA$1711.62—
CO$1289.75—
CT$1489.52—
DC$1369.37—
DE$1369.37—
FL$1468.46—
GA$1468.46—
HI$1960.17—
IA$1283.72—
ID$1469.19—
IL$1437.92—
IN$1437.92—
KS$1283.72—
KY$1468.46—
LA$1348.79—
MA$1489.52—
MD$1369.37—
ME$1489.52—
MI$1437.92—
MN$1437.92—
MO$1283.72—
MS$1468.46—
MT$1289.75—
NC$1468.46—
ND$1289.75—
NE$1283.72—
NH$1489.52—
NJ$1548.97—
NM$1348.79—
NV$1711.62—
NY$1548.97—
OH$1437.92—
OK$1348.79—
OR$1469.19—
PA$1369.37—
PR$1668.14—
RI$1489.52—
SC$1468.46—
SD$1289.75—
TN$1468.46—
TX$1348.79—
UT$1289.75—
VA$1369.37—
VI$1548.97—
VT$1489.52—
WA$1469.19—
WI$1437.92—
WV$1369.37—
WY$1289.75—
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 L1846 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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