MyMedi-AI

L8320 — Truss, addition to standard pad, water pad

HCPCS Level II L-code · short descriptor: “Truss addition to std pad wa”

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.

L8320 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $47.61 to $105.79 depending on state and rural status.

Former-CBA payment limits: ceiling $87.25 · floor $65.44

StateNon-ruralRural
AK$98.95—
AL$80.07—
AR$75.29—
AZ$87.25—
CA$87.25—
CO$65.44—
CT$86.67—
DC$73.10—
DE$73.10—
FL$80.07—
GA$80.07—
HI$105.79—
IA$65.44—
ID$68.42—
IL$75.90—
IN$75.90—
KS$65.44—
KY$80.07—
LA$75.29—
MA$86.67—
MD$73.10—
ME$86.67—
MI$75.90—
MN$75.90—
MO$65.44—
MS$80.07—
MT$65.44—
NC$80.07—
ND$65.44—
NE$65.44—
NH$86.67—
NJ$65.44—
NM$75.29—
NV$87.25—
NY$65.44—
OH$75.90—
OK$75.29—
OR$68.42—
PA$73.10—
PR$47.61—
RI$86.67—
SC$80.07—
SD$65.44—
TN$80.07—
TX$75.29—
UT$65.44—
VA$73.10—
VI$65.44—
VT$86.67—
WA$68.42—
WI$75.90—
WV$73.10—
WY$65.44—
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 L8320 at 2 units per date of service (clinical). Units above the MUE deny — typically as CO-151. Rationale: Nature of Equipment.

Common denial codes to watch

Related L-codes

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