MyMedi-AI

L7520 — Repair prosthetic device, labor component, per 15 minutes

HCPCS Level II L-code · short descriptor: “Repair prosthesis per 15 min”

Code system
HCPCS Level II
Family
L — Orthotics & prosthetics
Medicare coverage status
Carrier judgment — coverage decided by the DME MAC
DMEPOS payment category
LT
Prior authorization
Not on Medicare required-PA list
Face-to-face & WOPD
Not on the required list
MUE unit limit
12
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 2026-10-27; 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 2026-10-27; 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.

L7520 Medicare fee schedule (October 2026)

Base (no modifier) LT

Medicare allowable ranges from $40.67 to $63.34 depending on state and rural status.

StateNon-ruralRural
AK$50.77—
AL$40.67—
AR$40.67—
AZ$50.06—
CA$57.32—
CO$40.67—
CT$40.67—
DC$40.67—
DE$40.67—
FL$40.67—
GA$40.67—
HI$50.77—
IA$48.69—
ID$40.67—
IL$40.67—
IN$40.67—
KS$50.77—
KY$52.00—
LA$40.67—
MA$40.67—
MD$40.67—
ME$40.67—
MI$40.67—
MN$40.67—
MO$40.67—
MS$40.67—
MT$50.77—
NC$40.67—
ND$50.77—
NE$56.71—
NH$40.67—
NJ$40.67—
NM$40.67—
NV$55.43—
NY$40.67—
OH$40.67—
OK$40.67—
OR$58.49—
PA$40.67—
PR$40.67—
RI$40.67—
SC$40.67—
SD$54.38—
TN$40.67—
TX$40.67—
UT$63.34—
VA$40.67—
VI$40.67—
VT$40.67—
WA$52.16—
WI$40.67—
WV$40.67—
WY$56.71—
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 L7520 at 12 units per date of service (clinical). Units above the MUE deny — typically as CO-151. Rationale: Clinical: Data.

Common denial codes to watch

Related L-codes

Bill L7520 with confidence

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