Medicare coverage: Special coverage instructions apply
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 6 units per day (clinical), rationale: Clinical: CMS Workgroup
DME supplier: max 6 units per day (clinical), rationale: Clinical: Data
Medicare pricing for L8415
DMEPOS fee schedule, July 2026 (DME26-C)
no modifier, prosthetics and orthotics (PO): non-rural $26.24 to $34.99 in the contiguous states; $29.43 to $32.14 in AK, HI, PR and VI; ceiling $34.99, floor $26.24
Payer policies and prior authorization for L8415
Payer coverage policies that name L8415
L8415 appears in 3 coverage policies from Blue Cross & Blue Shield of Mississippi, Capital Blue Cross, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).
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.