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)
- Status
- Active (April 2026 HCPCS)
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.
L1846 Medicare fee schedule (April 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
| State | Non-rural | Rural |
|---|---|---|
| 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 | — |
Common denial codes to watch
Related L-codes
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