MyMedi-AI

L8501 — Tracheostomy speaking valve

HCPCS Level II L-code

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.

L8501 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $107.37 to $197.18 depending on state and rural status.

Former-CBA payment limits: ceiling $197.18 · floor $147.88

StateNon-ruralRural
AK$107.37—
AL$179.42—
AR$147.88—
AZ$147.88—
CA$147.88—
CO$147.88—
CT$197.18—
DC$147.88—
DE$147.88—
FL$179.42—
GA$179.42—
HI$114.77—
IA$147.88—
ID$147.88—
IL$147.88—
IN$147.88—
KS$147.88—
KY$179.42—
LA$147.88—
MA$197.18—
MD$147.88—
ME$197.18—
MI$147.88—
MN$147.88—
MO$147.88—
MS$179.42—
MT$147.88—
NC$179.42—
ND$147.88—
NE$147.88—
NH$197.18—
NJ$147.88—
NM$147.88—
NV$147.88—
NY$147.88—
OH$147.88—
OK$147.88—
OR$147.88—
PA$147.88—
PR$152.32—
RI$197.18—
SC$179.42—
SD$147.88—
TN$179.42—
TX$147.88—
UT$147.88—
VA$147.88—
VI$147.88—
VT$197.18—
WA$147.88—
WI$147.88—
WV$147.88—
WY$147.88—
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 L8501 at 2 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

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