L1850 Ko swedish type pre otsKnee orthosis, swedish type, prefabricated, off-the-shelf
5 of 5 payer prior-auth lists that name L1850 require prior authorization or set conditions: Humana, UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Humana | Humana Healthy Horizons | SC | prior auth required | Jan 1, 2027 | Humana Healthy Horizons in South Carolina Prior authorization and Notification List The following list describes services and medications that are commonly reviewed and may require additional clinical | |
| UnitedHealthcare Community Plan | AHCCCS Complete Care (ACC) | AZ | prior auth required | Oct 1, 2026 | Prior authorization requirements for AHCCCS Complete Care (ACC) Medicaid effective October 1, 2026 | |
| UnitedHealthcare Community Plan | ALTCS Developmentally Disabled | AZ | prior auth required | Oct 1, 2026 | Prior authorization requirements for Arizona Developmental Disabilities Effective October 1, 2026 | |
| UnitedHealthcare Community Plan | Louisiana Medicaid (Healthy Louisiana) | LA | prior auth under conditions | Prior authorization is required only for orthotic and prosthetics with a retail purchase or a cumulative rental cost of more than $500. | Jan 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Louisiana |
| UnitedHealthcare Community Plan | New Mexico Turquoise Care | NM | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of New Mexico Effective October 1, 2026 |
L1850 appears in 6 coverage policies from Aetna, Anthem, Blue Shield of California, Capital Blue Cross, Cigna.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Knee Braces (1094) | covered if criteria are met | Jan 20, 2026 | payer document |
| Aetna | Knee Braces (1094) | listed, no stance (range L1810-L1860) | Jan 20, 2026 | payer document |
| Aetna | Orthopedic Casts, Braces and Splints (0009) | listed, no stance (range L1600-L2999) | Jan 20, 2026 | payer document |
| Anthem | Prefabricated and Prophylactic Knee Braces (CG-OR-PR-02) | covered if criteria are met | Feb 19, 2026 | payer document |
| Blue Shield of California | BSC1.05 | Knee Braces (Custom) | listed, no stance | payer document | |
| Capital Blue Cross | Knee Braces (MP 6.012) Procedure Codes | covered if criteria are met | Sep 1, 2026 | payer document |
| Cigna | Orthotic Devices and Shoes (0543) | covered if criteria are met | Sep 15, 2026 | payer document |
Prior authorization required or conditional in LA, MA, MS, NY, OH, VA, WV.
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.