MyMedi-AI

L6805 — Addition to terminal device, modifier wrist unit

HCPCS Level II L-code · short descriptor: “Term dev modifier wrist unit”

Code system
HCPCS Level II
Family
L — Orthotics & prosthetics
Medicare coverage status
Special coverage instructions apply
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.

L6805 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $296.48 to $554.72 depending on state and rural status.

Former-CBA payment limits: ceiling $555.38 · floor $416.53

StateNon-ruralRural
AK$518.80—
AL$416.53—
AR$520.97—
AZ$518.39—
CA$518.39—
CO$435.97—
CT$442.69—
DC$440.68—
DE$440.68—
FL$416.53—
GA$416.53—
HI$554.72—
IA$532.91—
ID$517.80—
IL$472.26—
IN$472.26—
KS$532.91—
KY$416.53—
LA$520.97—
MA$442.69—
MD$440.68—
ME$442.69—
MI$472.26—
MN$472.26—
MO$532.91—
MS$416.53—
MT$435.97—
NC$416.53—
ND$435.97—
NE$532.91—
NH$442.69—
NJ$488.94—
NM$520.97—
NV$518.39—
NY$488.94—
OH$472.26—
OK$520.97—
OR$517.80—
PA$440.68—
PR$296.48—
RI$442.69—
SC$416.53—
SD$435.97—
TN$416.53—
TX$520.97—
UT$435.97—
VA$440.68—
VI$488.93—
VT$442.69—
WA$517.80—
WI$472.26—
WV$440.68—
WY$435.97—
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 L6805 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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