Medically Unlikely Edits (effective October 1, 2026)
Practitioner: max 0 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 1 units per day (policy), rationale: Anatomic Consideration
DME supplier: max 1 units per day (policy), rationale: Anatomic Consideration
Medicare pricing for L0120
DMEPOS fee schedule, July 2026 (DME26-C)
no modifier, prosthetics and orthotics (PO): non-rural $30.50 to $40.66 in the contiguous states; $30.50 to $60.33 in AK, HI, PR and VI; ceiling $40.66, floor $30.50
Payer policies and prior authorization for L0120
Payer coverage policies that name L0120
L0120 appears in 4 coverage policies from Aetna, Cigna.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.