MyMedi-AI

L8509 — Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type

HCPCS Level II L-code · short descriptor: “Trach-esoph voice pros md in”

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
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.

L8509 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $131.24 to $144.37 depending on state and rural status.

Former-CBA payment limits: ceiling $160.17 · floor $120.13

StateNon-ruralRural
AK$131.24—
AL$135.22—
AR$135.20—
AZ$131.24—
CA$131.24—
CO$135.93—
CT$131.24—
DC$131.24—
DE$131.24—
FL$135.22—
GA$135.22—
HI$131.24—
IA$133.79—
ID$131.24—
IL$134.48—
IN$134.48—
KS$133.79—
KY$135.22—
LA$135.20—
MA$131.24—
MD$131.24—
ME$131.24—
MI$134.48—
MN$134.48—
MO$133.79—
MS$135.22—
MT$135.93—
NC$135.22—
ND$135.93—
NE$133.79—
NH$131.24—
NJ$131.24—
NM$135.20—
NV$131.24—
NY$131.24—
OH$134.48—
OK$135.20—
OR$131.24—
PA$131.24—
PR$144.37—
RI$131.24—
SC$135.22—
SD$135.93—
TN$135.22—
TX$135.20—
UT$135.93—
VA$131.24—
VI$144.37—
VT$131.24—
WA$131.24—
WI$134.48—
WV$131.24—
WY$135.93—
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.

Common denial codes to watch

Related L-codes

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