MyMedi-AI

L8605 — Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, anal canal, 1 ml, includes shipping and necessary supplies

HCPCS Level II L-code · short descriptor: “Inj bulking agent anal canal”

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.

L8605 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $860.80 to $946.86 depending on state and rural status.

Former-CBA payment limits: ceiling $1050.74 · floor $788.06

StateNon-ruralRural
AK$860.80—
AL$886.74—
AR$886.61—
AZ$860.80—
CA$860.80—
CO$893.39—
CT$860.80—
DC$860.80—
DE$860.80—
FL$886.74—
GA$886.74—
HI$860.80—
IA$877.59—
ID$860.80—
IL$881.94—
IN$881.94—
KS$877.59—
KY$886.74—
LA$886.61—
MA$860.80—
MD$860.80—
ME$860.80—
MI$881.94—
MN$881.94—
MO$877.59—
MS$886.74—
MT$893.39—
NC$886.74—
ND$893.39—
NE$877.59—
NH$860.80—
NJ$860.80—
NM$886.61—
NV$860.80—
NY$860.80—
OH$881.94—
OK$886.61—
OR$860.80—
PA$860.80—
PR$946.86—
RI$860.80—
SC$886.74—
SD$893.39—
TN$886.74—
TX$886.61—
UT$893.39—
VA$860.80—
VI$946.86—
VT$860.80—
WA$860.80—
WI$881.94—
WV$860.80—
WY$893.39—
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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