MyMedi-AI

L7045 — Electric hook, switch or myoelectric controlled, pediatric

HCPCS Level II L-code · short descriptor: “Pediatric electric hook”

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.

L7045 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $1668.62 to $2638.38 depending on state and rural status.

Former-CBA payment limits: ceiling $2638.38 · floor $1978.79

StateNon-ruralRural
AK$1668.62—
AL$1978.79—
AR$2638.38—
AZ$1978.79—
CA$1978.79—
CO$1978.79—
CT$1978.79—
DC$1978.79—
DE$1978.79—
FL$1978.79—
GA$1978.79—
HI$1784.30—
IA$1978.79—
ID$1978.79—
IL$1978.79—
IN$1978.79—
KS$1978.79—
KY$1978.79—
LA$2638.38—
MA$1978.79—
MD$1978.79—
ME$1978.79—
MI$1978.79—
MN$1978.79—
MO$1978.79—
MS$1978.79—
MT$1978.79—
NC$1978.79—
ND$1978.79—
NE$1978.79—
NH$1978.79—
NJ$1978.79—
NM$2638.38—
NV$1978.79—
NY$1978.79—
OH$1978.79—
OK$2638.38—
OR$1978.79—
PA$1978.79—
PR$1857.50—
RI$1978.79—
SC$1978.79—
SD$1978.79—
TN$1978.79—
TX$2638.38—
UT$1978.79—
VA$1978.79—
VI$1978.79—
VT$1978.79—
WA$1978.79—
WI$1978.79—
WV$1978.79—
WY$1978.79—
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 L7045 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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