L1851 — Knee orthosis (ko), 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, prefabricated, off-the-shelf
HCPCS Level II L-code · short descriptor: “Ko single upright prefab ots” · 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 2022-10-10)
- Status
- Active (April 2026 HCPCS)
Prior authorization
PA REQUIRED L1851 is on Medicare's DMEPOS Required Prior Authorization List (Orthoses — nationwide since 2022-10-10).
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.
L1851 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $600.78 to $959.09 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $905.28 | — |
| AL | $734.28 | $921.47 |
| AR | $734.28 | $921.42 |
| AZ | $600.78 | $905.28 |
| CA | $600.78 | $905.28 |
| CO | $612.07 | $924.54 |
| CT | $711.10 | $905.28 |
| DC | $665.06 | $905.28 |
| DE | $665.06 | $905.28 |
| FL | $734.28 | $921.47 |
| GA | $734.28 | $921.47 |
| HI | $905.28 | — |
| IA | $662.62 | $915.79 |
| ID | $612.07 | $905.28 |
| IL | $672.67 | $918.49 |
| IN | $672.67 | $918.49 |
| KS | $662.62 | $915.79 |
| KY | $734.28 | $921.47 |
| LA | $734.28 | $921.42 |
| MA | $711.10 | $905.28 |
| MD | $665.06 | $905.28 |
| ME | $711.10 | $905.28 |
| MI | $672.67 | $918.49 |
| MN | $662.62 | $918.49 |
| MO | $662.62 | $915.79 |
| MS | $734.28 | $921.47 |
| MT | $612.07 | $924.54 |
| NC | $734.28 | $921.47 |
| ND | $662.62 | $924.54 |
| NE | $662.62 | $915.79 |
| NH | $711.10 | $905.28 |
| NJ | $665.06 | $905.28 |
| NM | $600.78 | $921.42 |
| NV | $600.78 | $905.28 |
| NY | $665.06 | $905.28 |
| OH | $672.67 | $918.49 |
| OK | $600.78 | $921.42 |
| OR | $600.78 | $905.28 |
| PA | $665.06 | $905.28 |
| PR | $959.09 | — |
| RI | $711.10 | $905.28 |
| SC | $734.28 | $921.47 |
| SD | $662.62 | $924.54 |
| TN | $734.28 | $921.47 |
| TX | $600.78 | $921.42 |
| UT | $612.07 | $924.54 |
| VA | $734.28 | $905.28 |
| VI | $959.09 | — |
| VT | $711.10 | $905.28 |
| WA | $600.78 | $905.28 |
| WI | $672.67 | $918.49 |
| WV | $734.28 | $905.28 |
| WY | $612.07 | $924.54 |
Common denial codes to watch
Related L-codes
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