L1852 — Knee orthosis (ko), 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, off-the-shelf

HCPCS Level II L-code · short descriptor: “Ko double 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 2026-04-13)
Status: Active (April 2026 HCPCS)

Prior authorization

PA REQUIRED L1852 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.

L1852 Medicare fee schedule (April 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $573.13 to $940.49 depending on state and rural status.

State	Non-rural	Rural
AK	$830.33	—
AL	$700.49	$928.91
AR	$700.49	$888.40
AZ	$573.13	$819.86
CA	$573.13	$819.86
CO	$583.90	$835.27
CT	$678.38	$850.63
DC	$634.46	$908.68
DE	$634.46	$908.68
FL	$700.49	$928.91
GA	$700.49	$928.91
HI	$863.62	—
IA	$632.13	$819.86
ID	$583.90	$837.96
IL	$641.72	$864.98
IN	$641.72	$864.98
KS	$632.13	$819.86
KY	$700.49	$928.91
LA	$700.49	$888.40
MA	$678.38	$850.63
MD	$634.46	$908.68
ME	$678.38	$850.63
MI	$641.72	$864.98
MN	$632.13	$864.98
MO	$632.13	$819.86
MS	$700.49	$928.91
MT	$583.90	$835.27
NC	$700.49	$928.91
ND	$632.13	$835.27
NE	$632.13	$819.86
NH	$678.38	$850.63
NJ	$634.46	$940.49
NM	$573.13	$888.40
NV	$573.13	$819.86
NY	$634.46	$940.49
OH	$641.72	$864.98
OK	$573.13	$888.40
OR	$573.13	$837.96
PA	$634.46	$908.68
PR	$902.28	—
RI	$678.38	$850.63
SC	$700.49	$928.91
SD	$632.13	$835.27
TN	$700.49	$928.91
TX	$573.13	$888.40
UT	$583.90	$835.27
VA	$700.49	$908.68
VI	$940.49	—
VT	$678.38	$850.63
WA	$573.13	$837.96
WI	$641.72	$864.98
WV	$700.49	$908.68
WY	$583.90	$835.27

Amounts are the Medicare DMEPOS fee-schedule allowables effective April 2026. 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.

Common denial codes to watch

CO-50 medical necessity CO-197 no prior auth

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