Medically Unlikely Edits (effective October 1, 2026)
Practitioner: max 0 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 2 units per day (clinical), rationale: Anatomic Consideration
DME supplier: max 2 units per day (clinical), rationale: Anatomic Consideration
Medicare pricing for L0978
DMEPOS fee schedule, July 2026 (DME26-C)
no modifier, prosthetics and orthotics (PO): non-rural $221.20 to $294.93 in the contiguous states; $81.66 to $692.78 in AK, HI, PR and VI; ceiling $294.93, floor $221.20
Payer policies and prior authorization for L0978
Payer coverage policies that name L0978
L0978 appears in 3 coverage policies from Aetna, Anthem.
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.