MyMedi-AI

L8603 — Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies

HCPCS Level II L-code · short descriptor: “Collagen imp urinary 2.5 ml”

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
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 2026-10-26; 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 2026-10-26; 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.

L8603 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $534.60 to $539.27 depending on state and rural status.

Former-CBA payment limits: ceiling $643.68 · floor $482.76

StateNon-ruralRural
AL$536.91—
AR$536.09—
AZ$536.80—
CA$536.80—
CO$536.09—
CT$536.09—
DC$536.09—
DE$536.09—
FL$536.91—
GA$536.91—
IA$536.09—
ID$539.27—
IL$536.09—
IN$536.09—
KS$536.09—
KY$536.91—
LA$536.09—
MA$536.09—
MD$536.09—
ME$536.09—
MI$536.09—
MN$536.09—
MO$536.09—
MS$536.91—
MT$536.09—
NC$536.91—
ND$536.09—
NE$536.09—
NH$536.09—
NJ$534.60—
NM$536.09—
NV$536.80—
NY$534.60—
OH$536.09—
OK$536.09—
OR$539.27—
PA$536.09—
RI$536.09—
SC$536.91—
SD$536.09—
TN$536.91—
TX$536.09—
UT$536.09—
VA$536.09—
VT$536.09—
WA$539.27—
WI$536.09—
WV$536.09—
WY$536.09—
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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