L1499 HCPCS code: Spinal orthosis, not otherwise specified
L1499 is the HCPCS Level II code for spinal orthosis, not otherwise specified. In 2024 Medicare paid an average of $546.85 per service for L1499 across 3,007 services. 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 rose 140% from 2022 to 2024 (1,251 to 3,007 services). In 2024, 139 suppliers billed Medicare for L1499 (purchases), serving 2,999 beneficiaries; Texas, California, Florida accounted for 41% of services.
Code details
| Field | Value |
|---|---|
| Section | L codes — Orthotic and prosthetic procedures and devices |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 46 — Priced by the Medicare contractor (no national fee) |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 1982-01-01 |
| Last action effective | 1998-01-01 |
Who bills L1499 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 139 |
| Referring clinicians | 1,904 |
| Medicare beneficiaries | 2,999 |
| States with claims | 38 |
| Share of services in top 3 states (Texas, California, Florida) | 41% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 100 | 1,250 |
| 2023 | 114 | 1,698 |
| 2024 | 139 | 2,999 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L1499, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 1,251 | 1,250 | $540.88 | $425.73 |
| 2023 | 1,702 | 1,698 | $693.37 | $542.65 |
| 2024 | 3,007 | 2,999 | $699.30 | $546.85 |
States with the most L1499 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 554 | $551.03 |
| California | 378 | $688.77 |
| Florida | 265 | $364.59 |
| Virginia | 171 | $622.41 |
| Washington | 137 | $572.99 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1 | Nature of Equipment |
| outpatient hospital claims | 1 | Nature of Equipment |
| practitioner claims | 1 | Nature of Equipment |
Medicare policy articles for this code
- A52500: Spinal Orthoses: TLSO and LSO - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
What changed for L1499
- 1982-01-01: L1499 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 L1499?
L1499 is the HCPCS Level II code for spinal orthosis, not otherwise specified. Short descriptor: "Spinal orthosis nos".
How much does Medicare pay for L1499?
In 2024, the average Medicare payment was $546.85 per service (average allowed $699.30).
Does Medicare cover L1499?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of L1499 can be billed per day?
1 on DME suppliers; 1 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).
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 L1499
- Watch L1499 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L1499
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; 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.