Addition to lower extremity, straight knee joint, heavy duty, each joint
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 4 units per day (policy), rationale: Anatomic Consideration
DME supplier: max 4 units per day (policy), rationale: Anatomic Consideration
Medicare pricing for L2385
DMEPOS fee schedule, July 2026 (DME26-C)
no modifier, prosthetics and orthotics (PO): non-rural $153.92 to $205.22 in the contiguous states; $51.03 to $225.93 in AK, HI, PR and VI; ceiling $205.22, floor $153.92
Payer policies and prior authorization for L2385
1 of 1 payer prior-auth lists that name L2385 require prior authorization or set conditions: Blue Shield of California Promise Health Plan.
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.