MyMedi-AI

L1850 — Knee orthosis, swedish type, prefabricated, off-the-shelf

HCPCS Level II L-code · short descriptor: “Ko swedish type pre ots”

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
Not on Medicare required-PA list
Face-to-face & WOPD
Not on the required list
MUE unit limit
2
Status
Active (HCPCS Level II October 2026)

Prior authorization

Not on the Medicare required-PA list (CMS Required Prior Authorization List — 74 items in force on 2026-10-25; 8 more from 2026-10-28; sources: CMS list updated 2026-01-13, CMS-6109-N (91 FR 47972)). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan 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.

L1850 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $205.78 to $408.53 depending on state and rural status.

StateNon-ruralRural
AK$390.22—
AL$251.50$291.13
AR$251.50$317.00
AZ$205.78$346.26
CA$205.78$346.26
CO$209.64$314.10
CT$243.56$329.15
DC$227.80$300.40
DE$227.80$300.40
FL$251.50$291.13
GA$251.50$291.13
HI$408.53—
IA$226.96$297.17
ID$209.64$310.43
IL$230.40$300.81
IN$230.40$300.81
KS$226.96$297.17
KY$251.50$291.13
LA$251.50$317.00
MA$243.56$329.15
MD$227.80$300.40
ME$243.56$329.15
MI$230.40$300.81
MN$226.96$300.81
MO$226.96$297.17
MS$251.50$291.13
MT$209.64$314.10
NC$251.50$291.13
ND$226.96$314.10
NE$226.96$297.17
NH$243.56$329.15
NJ$227.80$307.36
NM$205.78$317.00
NV$205.78$346.26
NY$227.80$307.36
OH$230.40$300.81
OK$205.78$317.00
OR$205.78$310.43
PA$227.80$300.40
PR$363.69—
RI$243.56$329.15
SC$251.50$291.13
SD$226.96$314.10
TN$251.50$291.13
TX$205.78$317.00
UT$209.64$314.10
VA$251.50$300.40
VI$307.36—
VT$243.56$329.15
WA$205.78$310.43
WI$230.40$300.81
WV$251.50$300.40
WY$209.64$314.10
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 L1850 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

Bill L1850 with confidence

Track prior-authorization requests with AI pre-fill and deadline tracking, and draft PA appeal letters — built for DME teams, PHI-free: no patient data is collected or stored.

Start free trial   Run a CMS-0057-F readiness check

Prefer DIY compliance? Self-audit documentation kits for DME suppliers →

Building an AI agent? Try the agent API in the playground — free PA-required lookups, L1850 included, and starter credits via POST /bot-marketplace/register.