Knee orthosis, elastic with joints, prefabricated, off-the-shelf
Medicare coverage: Carrier judgment
Status: active (October 2026 file)
Medically Unlikely Edits (effective October 1, 2026)
Practitioner: max 0 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 2 units per day (policy), rationale: Anatomic Consideration
DME supplier: max 2 units per day (policy), rationale: Anatomic Consideration
Medicare pricing for L1812
DMEPOS fee schedule, July 2026 (DME26-C)
no modifier, prosthetics and orthotics (PO): non-rural $70.12 to $85.71 in the contiguous states; $104.58 to $126.23 in AK, HI, PR and VI; rural $99.44 to $117.65
Payer policies and prior authorization for L1812
5 of 5 payer prior-auth lists that name L1812 require prior authorization or set conditions: Medicare, UnitedHealthcare Community Plan.
Payer
Plan
State
Prior auth
Conditions
Since
Source
Medicare
DMEPOS Probationary Prior Authorization (new suppliers)
All
prior auth under conditions
Newly enrolled or changed-ownership suppliers in their probationary year
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.