L4205 — Repair of orthotic device, labor component, per 15 minutes
HCPCS Level II L-code · short descriptor: “Ortho dvc repair per 15 min”
- Code system
- HCPCS Level II
- Family
- L — Orthotics & prosthetics
- Medicare coverage status
- Special coverage instructions apply
- DMEPOS payment category
- LT
- Prior authorization
- Not on Medicare required-PA list
- Status
- Active (April 2026 HCPCS)
Prior authorization
Not on the Medicare required-PA list as of the January 13, 2026 update (74 items). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.
L4205 Medicare fee schedule (April 2026)
Base (no modifier) LT
Medicare allowable ranges from $29.92 to $49.16 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $43.15 | — |
| AL | $29.95 | — |
| AR | $29.95 | — |
| AZ | $29.92 | — |
| CA | $49.16 | — |
| CO | $29.95 | — |
| CT | $30.64 | — |
| DC | $29.92 | — |
| DE | $29.92 | — |
| FL | $29.95 | — |
| GA | $29.95 | — |
| HI | $43.15 | — |
| IA | $29.92 | — |
| ID | $29.92 | — |
| IL | $29.92 | — |
| IN | $29.92 | — |
| KS | $29.92 | — |
| KY | $38.36 | — |
| LA | $29.95 | — |
| MA | $29.92 | — |
| MD | $29.92 | — |
| ME | $29.92 | — |
| MI | $29.92 | — |
| MN | $29.92 | — |
| MO | $29.92 | — |
| MS | $29.95 | — |
| MT | $29.92 | — |
| NC | $29.95 | — |
| ND | $43.06 | — |
| NE | $29.92 | — |
| NH | $29.92 | — |
| NJ | $29.92 | — |
| NM | $29.95 | — |
| NV | $29.92 | — |
| NY | $29.95 | — |
| OH | $29.92 | — |
| OK | $29.95 | — |
| OR | $29.92 | — |
| PA | $30.83 | — |
| PR | $29.95 | — |
| RI | $30.86 | — |
| SC | $29.95 | — |
| SD | $29.92 | — |
| TN | $29.95 | — |
| TX | $29.95 | — |
| UT | $29.92 | — |
| VA | $29.92 | — |
| VI | $29.95 | — |
| VT | $29.92 | — |
| WA | $43.90 | — |
| WI | $29.92 | — |
| WV | $29.92 | — |
| WY | $39.94 | — |
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
Related L-codes
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