MyMedi-AI

L8515 — Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each

HCPCS Level II L-code · short descriptor: “Gel cap app device for trach”

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
1
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.

L8515 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $75.84 to $83.45 depending on state and rural status.

Former-CBA payment limits: ceiling $92.57 · floor $69.43

StateNon-ruralRural
AK$75.84—
AL$78.14—
AR$78.14—
AZ$75.84—
CA$75.84—
CO$78.60—
CT$75.84—
DC$75.84—
DE$75.84—
FL$78.14—
GA$78.14—
HI$75.84—
IA$77.37—
ID$75.84—
IL$77.74—
IN$77.74—
KS$77.37—
KY$78.14—
LA$78.14—
MA$75.84—
MD$75.84—
ME$75.84—
MI$77.74—
MN$77.74—
MO$77.37—
MS$78.14—
MT$78.60—
NC$78.14—
ND$78.60—
NE$77.37—
NH$75.84—
NJ$75.84—
NM$78.14—
NV$75.84—
NY$75.84—
OH$77.74—
OK$78.14—
OR$75.84—
PA$75.84—
PR$83.45—
RI$75.84—
SC$78.14—
SD$78.60—
TN$78.14—
TX$78.14—
UT$78.60—
VA$75.84—
VI$83.45—
VT$75.84—
WA$75.84—
WI$77.74—
WV$75.84—
WY$78.60—
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 L8515 at 1 unit 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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