L0859 HCPCS code: Addition to halo procedure, magnetic resonance image compatible systems, rings and pins, any material
L0859 is the HCPCS Level II code for addition to halo procedure, magnetic resonance image compatible systems, rings and pins, any material. The 2026 Medicare DMEPOS fee schedule pays $1,256.43 to $1,866.53 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. Its average fee ranks 2 of 5 L08 codes (family range $263.56–$4,033.26).
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 | 2006-01-01 |
| Last action effective | 2006-01-01 |
2026 Medicare DMEPOS fee schedule for L0859
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $1,256.43 | $1,866.53 | $1,866.53 | $1,399.89 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $1,256.43 | — |
| AL | — | $1,399.89 | — |
| AR | — | $1,866.53 | — |
| AZ | — | $1,399.89 | — |
| CA | — | $1,399.89 | — |
| CO | — | $1,866.53 | — |
| CT | — | $1,487.20 | — |
| DC | — | $1,582.21 | — |
| DE | — | $1,582.21 | — |
| FL | — | $1,399.89 | — |
| GA | — | $1,399.89 | — |
| HI | — | $1,343.50 | — |
| IA | — | $1,399.89 | — |
| ID | — | $1,399.89 | — |
| IL | — | $1,399.89 | — |
| IN | — | $1,399.89 | — |
| KS | — | $1,399.89 | — |
| KY | — | $1,399.89 | — |
| LA | — | $1,866.53 | — |
| MA | — | $1,487.20 | — |
| MD | — | $1,582.21 | — |
| ME | — | $1,487.20 | — |
| MI | — | $1,399.89 | — |
| MN | — | $1,399.89 | — |
| MO | — | $1,399.89 | — |
| MS | — | $1,399.89 | — |
| MT | — | $1,866.53 | — |
| NC | — | $1,399.89 | — |
| ND | — | $1,866.53 | — |
| NE | — | $1,399.89 | — |
| NH | — | $1,487.20 | — |
| NJ | — | $1,399.89 | — |
| NM | — | $1,866.53 | — |
| NV | — | $1,399.89 | — |
| NY | — | $1,399.89 | — |
| OH | — | $1,399.89 | — |
| OK | — | $1,866.53 | — |
| OR | — | $1,399.89 | — |
| PA | — | $1,582.21 | — |
| PR | — | $1,416.27 | — |
| RI | — | $1,487.20 | — |
| SC | — | $1,399.89 | — |
| SD | — | $1,866.53 | — |
| TN | — | $1,399.89 | — |
| TX | — | $1,866.53 | — |
| UT | — | $1,866.53 | — |
| VA | — | $1,582.21 | — |
| VI | — | $1,399.89 | — |
| VT | — | $1,487.20 | — |
| WA | — | $1,399.89 | — |
| WI | — | $1,399.89 | — |
| WV | — | $1,582.21 | — |
| WY | — | $1,866.53 | — |
How the L0859 fee compares
| Measure | Value |
|---|---|
| Rank among 5 L08 codes (lowest = 1) | 2 |
| Family fee range (average of state fees) | $263.56–$4,033.26 |
| Rural fee uplift | — |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1 | Code Descriptor / CPT Instruction |
| outpatient hospital claims | 1 | Code Descriptor / CPT Instruction |
What changed for L0859
- 2026-01-01: Average state fee rose 2.0%: $1,493.93 to $1,523.80
- 2006-01-01: L0859 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 L0859?
L0859 is the HCPCS Level II code for addition to halo procedure, magnetic resonance image compatible systems, rings and pins, any material. Short descriptor: "Mri compatible system".
How much does Medicare pay for L0859?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $1,256.43–$1,866.53. Rural fees can be higher.
Does Medicare cover L0859?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L0859 change in 2026?
The average non-rural state fee moved from $1,493.93 in 2025 to $1,523.80 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L0859 can be billed per day?
1 on DME suppliers; 1 on outpatient hospital claims (NCCI medically unlikely edits).
Related L08 codes
- L0810 — Halo procedure, cervical halo incorporated into jacket vest ($2,709.68–$4,706.46)
- L0820 — Halo procedure, cervical halo incorporated into plaster body jacket ($1,758.88–$3,309.59)
- L0830 — Halo procedure, cervical halo incorporated into milwaukee type orthosis ($3,067.55–$6,964.46)
- L0861 — Addition to halo procedure, replacement liner/interface material ($258.53–$284.37)
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Next steps
- Run a reimbursement report for a device billed under L0859
- Watch L0859 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L0859
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.