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 12 units per day (clinical), rationale: Clinical: CMS Workgroup
DME supplier: max 12 units per day (clinical), rationale: Clinical: Data
Medicare pricing for L8435
DMEPOS fee schedule, July 2026 (DME26-C)
no modifier, prosthetics and orthotics (PO): non-rural $25.74 to $34.32 in the contiguous states; $26.91 to $35.23 in AK, HI, PR and VI; ceiling $34.32, floor $25.74
Payer policies and prior authorization for L8435
Payer coverage policies that name L8435
L8435 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.