MyMedi-AI

L4045 — Replace non-molded thigh lacer, for custom fabricated orthosis only

HCPCS Level II L-code · short descriptor: “Replace non-molded thigh lac”

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.

L4045 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $376.94 to $738.06 depending on state and rural status.

Former-CBA payment limits: ceiling $502.59 · floor $376.94

StateNon-ruralRural
AK$690.22—
AL$376.94—
AR$376.94—
AZ$502.59—
CA$502.59—
CO$453.73—
CT$502.59—
DC$376.94—
DE$376.94—
FL$376.94—
GA$376.94—
HI$738.06—
IA$405.87—
ID$380.26—
IL$376.94—
IN$376.94—
KS$405.87—
KY$376.94—
LA$376.94—
MA$502.59—
MD$376.94—
ME$502.59—
MI$376.94—
MN$376.94—
MO$405.87—
MS$376.94—
MT$453.73—
NC$376.94—
ND$453.73—
NE$405.87—
NH$502.59—
NJ$376.94—
NM$376.94—
NV$502.59—
NY$376.94—
OH$376.94—
OK$376.94—
OR$380.26—
PA$376.94—
PR$428.29—
RI$502.59—
SC$376.94—
SD$453.73—
TN$376.94—
TX$376.94—
UT$453.73—
VA$376.94—
VI$376.94—
VT$502.59—
WA$380.26—
WI$376.94—
WV$376.94—
WY$453.73—
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 L4045 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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