L0160 HCPCS code: Cervical, semi-rigid, wire frame occipital/mandibular support, prefabricated, off-the-shelf
L0160 is the HCPCS Level II code for cervical, semi-rigid, wire frame occipital/mandibular support, prefabricated, off-the-shelf. The 2026 Medicare DMEPOS fee schedule pays $179.98 to $239.97 depending on the state. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 1 per day on DME suppliers. Medicare volume fell 32% from 2022 to 2024 (196 to 133 services). In 2024, 99 suppliers billed Medicare for L0160 (purchases), serving 133 beneficiaries. Its average fee ranks 5 of 12 L01 codes (family range $35.00–$1,711.51).
Code details
| Field | Value |
|---|---|
| Section | L codes — Orthotic and prosthetic procedures and devices |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 38 — DMEPOS: orthotics, prosthetics, prosthetic devices and vision services |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 1982-01-01 |
| Last action effective | 2014-01-01 |
2026 Medicare DMEPOS fee schedule for L0160
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $179.98 | $239.97 | $239.97 | $179.98 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $204.46 | — |
| AL | — | $204.81 | — |
| AR | — | $239.97 | — |
| AZ | — | $203.13 | — |
| CA | — | $203.13 | — |
| CO | — | $179.98 | — |
| CT | — | $239.97 | — |
| DC | — | $179.98 | — |
| DE | — | $179.98 | — |
| FL | — | $204.81 | — |
| GA | — | $204.81 | — |
| HI | — | $218.68 | — |
| IA | — | $200.13 | — |
| ID | — | $179.98 | — |
| IL | — | $192.08 | — |
| IN | — | $192.08 | — |
| KS | — | $200.13 | — |
| KY | — | $204.81 | — |
| LA | — | $239.97 | — |
| MA | — | $239.97 | — |
| MD | — | $179.98 | — |
| ME | — | $239.97 | — |
| MI | — | $192.08 | — |
| MN | — | $192.08 | — |
| MO | — | $200.13 | — |
| MS | — | $204.81 | — |
| MT | — | $179.98 | — |
| NC | — | $204.81 | — |
| ND | — | $179.98 | — |
| NE | — | $200.13 | — |
| NH | — | $239.97 | — |
| NJ | — | $192.56 | — |
| NM | — | $239.97 | — |
| NV | — | $203.13 | — |
| NY | — | $192.56 | — |
| OH | — | $192.08 | — |
| OK | — | $239.97 | — |
| OR | — | $179.98 | — |
| PA | — | $179.98 | — |
| PR | — | $182.74 | — |
| RI | — | $239.97 | — |
| SC | — | $204.81 | — |
| SD | — | $179.98 | — |
| TN | — | $204.81 | — |
| TX | — | $239.97 | — |
| UT | — | $179.98 | — |
| VA | — | $179.98 | — |
| VI | — | $192.56 | — |
| VT | — | $239.97 | — |
| WA | — | $179.98 | — |
| WI | — | $192.08 | — |
| WV | — | $179.98 | — |
| WY | — | $179.98 | — |
How the L0160 fee compares
| Measure | Value |
|---|---|
| Rank among 12 L01 codes (lowest = 1) | 5 |
| Family fee range (average of state fees) | $35.00–$1,711.51 |
| Rural fee uplift | — |
Who bills L0160 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 99 |
| Referring clinicians | 115 |
| Medicare beneficiaries | 133 |
| States with claims | 2 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 161 | 195 |
| 2023 | 128 | 177 |
| 2024 | 99 | 133 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L0160, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 196 | 195 | $172.31 | $128.08 |
| 2023 | 177 | 177 | $183.63 | $136.67 |
| 2024 | 133 | 133 | $192.86 | $144.19 |
States with the most L0160 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 17 | $145.17 |
| Minnesota | 14 | $144.61 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1 | Anatomic Consideration |
| outpatient hospital claims | 1 | Anatomic Consideration |
What changed for L0160
- 2026-01-01: Average state fee rose 2.0%: $198.37 to $202.34
- 1982-01-01: L0160 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code L0160?
L0160 is the HCPCS Level II code for cervical, semi-rigid, wire frame occipital/mandibular support, prefabricated, off-the-shelf. Short descriptor: "Cerv sr wire occ/man pre ots".
How much does Medicare pay for L0160?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $179.98–$239.97. Rural fees can be higher.
Does Medicare cover L0160?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L0160 change in 2026?
The average non-rural state fee moved from $198.37 in 2025 to $202.34 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L0160 can be billed per day?
1 on DME suppliers; 1 on outpatient hospital claims (NCCI medically unlikely edits).
Related L01 codes
- L0112 — Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated ($1,678.86–$1,846.76)
- L0113 — Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment ($342.07–$376.32)
- L0120 — Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar) ($30.50–$60.33)
- L0130 — Cervical, flexible, thermoplastic collar, molded to patient ($187.48–$733.83)
- L0140 — Cervical, semi-rigid, adjustable (plastic collar) ($64.20–$142.76)
- L0150 — Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibular/occipital piece) ($124.18–$172.80)
- L0170 — Cervical, collar, molded to patient model ($729.99–$1,050.52)
- L0172 — Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf ($145.89–$199.42)
- L0174 — Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf ($247.47–$537.31)
- L0180 — Cervical, multiple post collar, occipital/mandibular supports, adjustable ($425.78–$587.47)
- L0190 — Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars (somi, guilford, taylor types) ($569.23–$880.70)
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under L0160
- Watch L0160 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L0160
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.