MyMedi-AI

L2520 — Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, custom fitted

HCPCS Level II L-code · short descriptor: “Th/wght bear quad-lat brim c”

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 2026-10-26; 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 2026-10-26; 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.

L2520 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $529.38 to $856.60 depending on state and rural status.

Former-CBA payment limits: ceiling $705.84 · floor $529.38

StateNon-ruralRural
AK$713.42—
AL$529.38—
AR$605.28—
AZ$705.84—
CA$705.84—
CO$566.56—
CT$684.73—
DC$552.74—
DE$552.74—
FL$529.38—
GA$529.38—
HI$762.91—
IA$529.38—
ID$559.39—
IL$660.58—
IN$660.58—
KS$529.38—
KY$529.38—
LA$605.28—
MA$684.73—
MD$552.74—
ME$684.73—
MI$660.58—
MN$660.58—
MO$529.38—
MS$529.38—
MT$566.56—
NC$529.38—
ND$566.56—
NE$529.38—
NH$684.73—
NJ$652.24—
NM$605.28—
NV$705.84—
NY$652.24—
OH$660.58—
OK$605.28—
OR$559.39—
PA$552.74—
PR$856.60—
RI$684.73—
SC$529.38—
SD$566.56—
TN$529.38—
TX$605.28—
UT$566.56—
VA$552.74—
VI$652.23—
VT$684.73—
WA$559.39—
WI$660.58—
WV$552.74—
WY$566.56—
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 L2520 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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