L0861 HCPCS code: Addition to halo procedure, replacement liner/interface material
L0861 is the HCPCS Level II code for addition to halo procedure, replacement liner/interface material. The 2026 Medicare DMEPOS fee schedule pays $258.53 to $284.37 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 1 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 | 2004-01-01 |
| Last action effective | 2004-01-01 |
2026 Medicare DMEPOS fee schedule for L0861
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $258.53 | $284.37 | $315.50 | $236.63 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $258.53 | — |
| AL | — | $266.32 | — |
| AR | — | $266.31 | — |
| AZ | — | $258.53 | — |
| CA | — | $258.53 | — |
| CO | — | $267.79 | — |
| CT | — | $258.53 | — |
| DC | — | $258.53 | — |
| DE | — | $258.53 | — |
| FL | — | $266.32 | — |
| GA | — | $266.32 | — |
| HI | — | $258.53 | — |
| IA | — | $263.56 | — |
| ID | — | $258.53 | — |
| IL | — | $264.89 | — |
| IN | — | $264.89 | — |
| KS | — | $263.56 | — |
| KY | — | $266.32 | — |
| LA | — | $266.31 | — |
| MA | — | $258.53 | — |
| MD | — | $258.53 | — |
| ME | — | $258.53 | — |
| MI | — | $264.89 | — |
| MN | — | $264.89 | — |
| MO | — | $263.56 | — |
| MS | — | $266.32 | — |
| MT | — | $267.79 | — |
| NC | — | $266.32 | — |
| ND | — | $267.79 | — |
| NE | — | $263.56 | — |
| NH | — | $258.53 | — |
| NJ | — | $258.53 | — |
| NM | — | $266.31 | — |
| NV | — | $258.53 | — |
| NY | — | $258.53 | — |
| OH | — | $264.89 | — |
| OK | — | $266.31 | — |
| OR | — | $258.53 | — |
| PA | — | $258.53 | — |
| PR | — | $284.37 | — |
| RI | — | $258.53 | — |
| SC | — | $266.32 | — |
| SD | — | $267.79 | — |
| TN | — | $266.32 | — |
| TX | — | $266.31 | — |
| UT | — | $267.79 | — |
| VA | — | $258.53 | — |
| VI | — | $284.37 | — |
| VT | — | $258.53 | — |
| WA | — | $258.53 | — |
| WI | — | $264.89 | — |
| WV | — | $258.53 | — |
| WY | — | $267.79 | — |
How the L0861 fee compares
| Measure | Value |
|---|---|
| Rank among 5 L08 codes (lowest = 1) | 1 |
| 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 L0861
- 2026-01-01: Average state fee rose 2.0%: $258.40 to $263.56
- 2004-01-01: L0861 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 L0861?
L0861 is the HCPCS Level II code for addition to halo procedure, replacement liner/interface material. Short descriptor: "Halo repl liner/interface".
How much does Medicare pay for L0861?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $258.53–$284.37. Rural fees can be higher.
Does Medicare cover L0861?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L0861 change in 2026?
The average non-rural state fee moved from $258.40 in 2025 to $263.56 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L0861 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)
- L0859 — Addition to halo procedure, magnetic resonance image compatible systems, rings and pins, any material ($1,256.43–$1,866.53)
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Next steps
- Run a reimbursement report for a device billed under L0861
- Watch L0861 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L0861
Sources: CMS HCPCS Level II release October 2026; 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.