MyMedi-AI

L7190 — Electronic elbow, adolescent, variety village or equal, myoelectronically controlled

HCPCS Level II L-code · short descriptor: “Elbow adolescent myoelectron”

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.

L7190 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $9330.76 to $13407.96 depending on state and rural status.

Former-CBA payment limits: ceiling $12331.36 · floor $9248.52

StateNon-ruralRural
AK$9733.29—
AL$9450.26—
AR$12331.36—
AZ$9600.27—
CA$9600.27—
CO$9886.43—
CT$10117.89—
DC$9568.74—
DE$9568.74—
FL$9450.26—
GA$9450.26—
HI$10407.87—
IA$9330.76—
ID$9754.53—
IL$10332.65—
IN$10332.65—
KS$9330.76—
KY$9450.26—
LA$12331.36—
MA$10117.89—
MD$9568.74—
ME$10117.89—
MI$10332.65—
MN$10332.65—
MO$9330.76—
MS$9450.26—
MT$9886.43—
NC$9450.26—
ND$9886.43—
NE$9330.76—
NH$10117.89—
NJ$12331.36—
NM$12331.36—
NV$9600.27—
NY$12331.36—
OH$10332.65—
OK$12331.36—
OR$9754.53—
PA$9568.74—
PR$13407.96—
RI$10117.89—
SC$9450.26—
SD$9886.43—
TN$9450.26—
TX$12331.36—
UT$9886.43—
VA$9568.74—
VI$12331.36—
VT$10117.89—
WA$9754.53—
WI$10332.65—
WV$9568.74—
WY$9886.43—
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 L7190 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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