L1310 HCPCS code: Other scoliosis procedure, post-operative body jacket
L1310 is the HCPCS Level II code for other scoliosis procedure, post-operative body jacket. The 2026 Medicare DMEPOS fee schedule pays $1,975.19 to $2,631.87 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.
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 | 1986-01-01 |
2026 Medicare DMEPOS fee schedule for L1310
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $1,975.19 | $2,631.87 | $2,633.59 | $1,975.19 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $2,461.31 | — |
| AL | — | $1,975.19 | — |
| AR | — | $2,131.40 | — |
| AZ | — | $2,405.14 | — |
| CA | — | $2,405.14 | — |
| CO | — | $2,526.04 | — |
| CT | — | $2,197.59 | — |
| DC | — | $2,174.83 | — |
| DE | — | $2,174.83 | — |
| FL | — | $1,975.19 | — |
| GA | — | $1,975.19 | — |
| HI | — | $2,631.87 | — |
| IA | — | $2,202.99 | — |
| ID | — | $2,174.28 | — |
| IL | — | $2,206.15 | — |
| IN | — | $2,206.15 | — |
| KS | — | $2,202.99 | — |
| KY | — | $1,975.19 | — |
| LA | — | $2,131.40 | — |
| MA | — | $2,197.59 | — |
| MD | — | $2,174.83 | — |
| ME | — | $2,197.59 | — |
| MI | — | $2,206.15 | — |
| MN | — | $2,206.15 | — |
| MO | — | $2,202.99 | — |
| MS | — | $1,975.19 | — |
| MT | — | $2,526.04 | — |
| NC | — | $1,975.19 | — |
| ND | — | $2,526.04 | — |
| NE | — | $2,202.99 | — |
| NH | — | $2,197.59 | — |
| NJ | — | $2,549.09 | — |
| NM | — | $2,131.40 | — |
| NV | — | $2,405.14 | — |
| NY | — | $2,549.09 | — |
| OH | — | $2,206.15 | — |
| OK | — | $2,131.40 | — |
| OR | — | $2,174.28 | — |
| PA | — | $2,174.83 | — |
| PR | — | $2,249.52 | — |
| RI | — | $2,197.59 | — |
| SC | — | $1,975.19 | — |
| SD | — | $2,526.04 | — |
| TN | — | $1,975.19 | — |
| TX | — | $2,131.40 | — |
| UT | — | $2,526.04 | — |
| VA | — | $2,174.83 | — |
| VI | — | $2,549.10 | — |
| VT | — | $2,197.59 | — |
| WA | — | $2,174.28 | — |
| WI | — | $2,206.15 | — |
| WV | — | $2,174.83 | — |
| WY | — | $2,526.04 | — |
How the L1310 fee compares
| Measure | Value |
|---|---|
| Rank among 2 L13 codes (lowest = 1) | 2 |
| Family fee range (average of state fees) | $2,197.71–$2,238.23 |
| 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 L1310
- 2026-01-01: Average state fee rose 2.0%: $2,194.35 to $2,238.23
- 1986-01-01: L1310 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 L1310?
L1310 is the HCPCS Level II code for other scoliosis procedure, post-operative body jacket. Short descriptor: "Post-operative body jacket".
How much does Medicare pay for L1310?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $1,975.19–$2,631.87. Rural fees can be higher.
Does Medicare cover L1310?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L1310 change in 2026?
The average non-rural state fee moved from $2,194.35 in 2025 to $2,238.23 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L1310 can be billed per day?
1 on DME suppliers; 1 on outpatient hospital claims (NCCI medically unlikely edits).
Related L13 codes
- L1300 — Other scoliosis procedure, body jacket molded to patient model ($1,919.53–$3,013.95)
- L1320 — Thoracic, pectus carinatum orthosis, sternal compression, rigid circumferential frame with anterior and posterior rigid pads, custom fabricated
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Next steps
- Run a reimbursement report for a device billed under L1310
- Watch L1310 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L1310
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.