L1005 HCPCS code: Tension based scoliosis orthosis and accessory pads, includes fitting and adjustment
L1005 is the HCPCS Level II code for tension based scoliosis orthosis and accessory pads, includes fitting and adjustment. The 2026 Medicare DMEPOS fee schedule pays $3,839.20 to $4,223.13 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 14 of 14 L10 codes (family range $71.30–$3,913.88).
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 | 2002-01-01 |
| Last action effective | 2002-01-01 |
2026 Medicare DMEPOS fee schedule for L1005
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $3,839.20 | $4,223.13 | $4,685.17 | $3,513.88 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $3,839.20 | — |
| AL | — | $3,954.81 | — |
| AR | — | $3,954.38 | — |
| AZ | — | $3,839.20 | — |
| CA | — | $3,839.20 | — |
| CO | — | $3,976.59 | — |
| CT | — | $3,839.20 | — |
| DC | — | $3,839.20 | — |
| DE | — | $3,839.20 | — |
| FL | — | $3,954.81 | — |
| GA | — | $3,954.81 | — |
| HI | — | $3,839.20 | — |
| IA | — | $3,914.12 | — |
| ID | — | $3,839.20 | — |
| IL | — | $3,933.46 | — |
| IN | — | $3,933.46 | — |
| KS | — | $3,914.12 | — |
| KY | — | $3,954.81 | — |
| LA | — | $3,954.38 | — |
| MA | — | $3,839.20 | — |
| MD | — | $3,839.20 | — |
| ME | — | $3,839.20 | — |
| MI | — | $3,933.46 | — |
| MN | — | $3,933.46 | — |
| MO | — | $3,914.12 | — |
| MS | — | $3,954.81 | — |
| MT | — | $3,976.59 | — |
| NC | — | $3,954.81 | — |
| ND | — | $3,976.59 | — |
| NE | — | $3,914.12 | — |
| NH | — | $3,839.20 | — |
| NJ | — | $3,839.20 | — |
| NM | — | $3,954.38 | — |
| NV | — | $3,839.20 | — |
| NY | — | $3,839.20 | — |
| OH | — | $3,933.46 | — |
| OK | — | $3,954.38 | — |
| OR | — | $3,839.20 | — |
| PA | — | $3,839.20 | — |
| PR | — | $4,223.13 | — |
| RI | — | $3,839.20 | — |
| SC | — | $3,954.81 | — |
| SD | — | $3,976.59 | — |
| TN | — | $3,954.81 | — |
| TX | — | $3,954.38 | — |
| UT | — | $3,976.59 | — |
| VA | — | $3,839.20 | — |
| VI | — | $4,223.13 | — |
| VT | — | $3,839.20 | — |
| WA | — | $3,839.20 | — |
| WI | — | $3,933.46 | — |
| WV | — | $3,839.20 | — |
| WY | — | $3,976.59 | — |
How the L1005 fee compares
| Measure | Value |
|---|---|
| Rank among 14 L10 codes (lowest = 1) | 14 |
| Family fee range (average of state fees) | $71.30–$3,913.88 |
| Rural fee uplift | — |
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 L1005
- 2026-01-01: Average state fee rose 2.0%: $3,837.14 to $3,913.88
- 2002-01-01: L1005 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 L1005?
L1005 is the HCPCS Level II code for tension based scoliosis orthosis and accessory pads, includes fitting and adjustment. Short descriptor: "Tension based scoliosis orth".
How much does Medicare pay for L1005?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $3,839.20–$4,223.13. Rural fees can be higher.
Does Medicare cover L1005?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L1005 change in 2026?
The average non-rural state fee moved from $3,837.14 in 2025 to $3,913.88 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L1005 can be billed per day?
1 on DME suppliers; 1 on outpatient hospital claims (NCCI medically unlikely edits).
Related L10 codes
- L1000 — Cervical-thoracic-lumbar-sacral orthosis (ctlso) (milwaukee), inclusive of furnishing initial orthosis, including model ($2,332.97–$4,062.52)
- L1001 — Cervical thoracic lumbar sacral orthosis, immobilizer, infant size, prefabricated, includes fitting and adjustment
- L1006 — Scoliosis orthosis, sagittal-coronal control provided by a rigid lateral frame, extends from axilla to trochanter, includes all accessory pads, straps and interface, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise ($1,309.09–$1,309.09)
- L1007 — Scoliosis orthosis, sagittal-coronal control provided by a rigid lateral frame, extends from axilla, to trochanter, includes all accessory pads, straps, and interface, custom fabricated
- L1010 — Addition to cervical-thoracic-lumbar-sacral orthosis (ctlso) or scoliosis orthosis, axilla sling ($51.03–$102.83)
- L1020 — Addition to ctlso or scoliosis orthosis, kyphosis pad ($66.65–$184.59)
- L1025 — Addition to ctlso or scoliosis orthosis, kyphosis pad, floating ($143.30–$323.62)
- L1030 — Addition to ctlso or scoliosis orthosis, lumbar bolster pad ($71.58–$97.47)
- L1040 — Addition to ctlso or scoliosis orthosis, lumbar or lumbar rib pad ($51.17–$166.02)
- L1050 — Addition to ctlso or scoliosis orthosis, sternal pad ($51.17–$141.90)
- L1060 — Addition to ctlso or scoliosis orthosis, thoracic pad ($81.66–$170.96)
- L1070 — Addition to ctlso or scoliosis orthosis, trapezius sling ($68.51–$144.98)
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Next steps
- Run a reimbursement report for a device billed under L1005
- Watch L1005 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L1005
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.