MyMedi-AI

L2265 — Addition to lower extremity, long tongue stirrup

HCPCS Level II L-code · short descriptor: “Long tongue stirrup”

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.

L2265 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $135.33 to $352.26 depending on state and rural status.

Former-CBA payment limits: ceiling $180.44 · floor $135.33

StateNon-ruralRural
AK$329.43—
AL$135.33—
AR$180.44—
AZ$180.44—
CA$180.44—
CO$135.33—
CT$180.44—
DC$135.33—
DE$135.33—
FL$135.33—
GA$135.33—
HI$352.26—
IA$138.12—
ID$135.33—
IL$165.21—
IN$165.21—
KS$138.12—
KY$135.33—
LA$180.44—
MA$180.44—
MD$135.33—
ME$180.44—
MI$165.21—
MN$165.21—
MO$138.12—
MS$135.33—
MT$135.33—
NC$135.33—
ND$135.33—
NE$138.12—
NH$180.44—
NJ$135.33—
NM$180.44—
NV$180.44—
NY$135.33—
OH$165.21—
OK$180.44—
OR$135.33—
PA$135.33—
PR$161.82—
RI$180.44—
SC$135.33—
SD$135.33—
TN$135.33—
TX$180.44—
UT$135.33—
VA$135.33—
VI$135.33—
VT$180.44—
WA$135.33—
WI$165.21—
WV$135.33—
WY$135.33—
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 L2265 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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