L1640 HCPCS code: Hip orthosis, abduction control of hip joints, static, pelvic band or spreader bar, thigh cuffs, custom fabricated
L1640 is the HCPCS Level II code for hip orthosis, abduction control of hip joints, static, pelvic band or spreader bar, thigh cuffs, custom fabricated. The 2026 Medicare DMEPOS fee schedule pays $458.97 to $1,142.13 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 9 of 14 L16 codes (family range $57.38–$2,410.76).
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 | 1982-01-01 |
| Last action effective | 2001-01-01 |
2026 Medicare DMEPOS fee schedule for L1640
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $458.97 | $1,142.13 | $706.99 | $530.24 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $458.97 | — |
| AL | — | $530.24 | — |
| AR | — | $610.60 | — |
| AZ | — | $530.24 | — |
| CA | — | $530.24 | — |
| CO | — | $650.57 | — |
| CT | — | $706.99 | — |
| DC | — | $592.73 | — |
| DE | — | $592.73 | — |
| FL | — | $530.24 | — |
| GA | — | $530.24 | — |
| HI | — | $490.76 | — |
| IA | — | $598.53 | — |
| ID | — | $554.69 | — |
| IL | — | $581.79 | — |
| IN | — | $581.79 | — |
| KS | — | $598.53 | — |
| KY | — | $530.24 | — |
| LA | — | $610.60 | — |
| MA | — | $706.99 | — |
| MD | — | $592.73 | — |
| ME | — | $706.99 | — |
| MI | — | $581.79 | — |
| MN | — | $581.79 | — |
| MO | — | $598.53 | — |
| MS | — | $530.24 | — |
| MT | — | $650.57 | — |
| NC | — | $530.24 | — |
| ND | — | $650.57 | — |
| NE | — | $598.53 | — |
| NH | — | $706.99 | — |
| NJ | — | $619.54 | — |
| NM | — | $610.60 | — |
| NV | — | $530.24 | — |
| NY | — | $619.54 | — |
| OH | — | $581.79 | — |
| OK | — | $610.60 | — |
| OR | — | $554.69 | — |
| PA | — | $592.73 | — |
| PR | — | $1,142.13 | — |
| RI | — | $706.99 | — |
| SC | — | $530.24 | — |
| SD | — | $650.57 | — |
| TN | — | $530.24 | — |
| TX | — | $610.60 | — |
| UT | — | $650.57 | — |
| VA | — | $592.73 | — |
| VI | — | $619.54 | — |
| VT | — | $706.99 | — |
| WA | — | $554.69 | — |
| WI | — | $581.79 | — |
| WV | — | $592.73 | — |
| WY | — | $650.57 | — |
How the L1640 fee compares
| Measure | Value |
|---|---|
| Rank among 14 L16 codes (lowest = 1) | 9 |
| Family fee range (average of state fees) | $57.38–$2,410.76 |
| 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 L1640
- 2026-01-01: Average state fee rose 2.0%: $593.54 to $605.41
- 1982-01-01: L1640 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 L1640?
L1640 is the HCPCS Level II code for hip orthosis, abduction control of hip joints, static, pelvic band or spreader bar, thigh cuffs, custom fabricated. Short descriptor: "Pelv band/spread bar thigh c".
How much does Medicare pay for L1640?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $458.97–$1,142.13. Rural fees can be higher.
Does Medicare cover L1640?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L1640 change in 2026?
The average non-rural state fee moved from $593.54 in 2025 to $605.41 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L1640 can be billed per day?
1 on DME suppliers; 1 on outpatient hospital claims (NCCI medically unlikely edits).
Related L16 codes
- L1600 — Hip orthosis, abduction control of hip joints, flexible, frejka type with cover, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an inidividual with expertise ($148.08–$329.89)
- L1610 — Hip orthosis, abduction control of hip joints, flexible, (frejka cover only), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise ($48.44–$75.43)
- L1620 — Hip orthosis, abduction control of hip joints, flexible, (pavlik harness), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise ($153.96–$205.58)
- L1630 — Hip orthosis, abduction control of hip joints, semi-flexible (von rosen type), custom fabricated ($170.36–$259.63)
- L1650 — Hip orthosis, abduction control of hip joints, static, adjustable, (ilfled type), prefabricated, includes fitting and adjustment ($189.69–$351.91)
- L1652 — Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, includes fitting and adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise ($427.56–$470.32)
- L1653 — Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, off the shelf ($427.56–$470.32)
- L1660 — Hip orthosis, abduction control of hip joints, static, plastic, prefabricated, includes fitting and adjustment ($182.17–$262.21)
- L1680 — Hip orthosis, abduction control of hip joints, dynamic, pelvic control, adjustable hip motion control, thigh cuffs (rancho hip action type), custom fabricated ($1,400.11–$3,215.45)
- L1681 — Hip orthosis, bilateral hip joints and thigh cuffs, adjustable flexion, extension, abduction control of hip joint, postoperative hip abduction type, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise ($2,096.44–$3,461.66)
- L1685 — Hip orthosis, abduction control of hip joint, postoperative hip abduction type, custom fabricated ($1,366.86–$2,740.53)
- L1686 — Hip orthosis, abduction control of hip joint, postoperative hip abduction type, prefabricated, includes fitting and adjustment ($1,048.22–$1,730.83)
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Next steps
- Run a reimbursement report for a device billed under L1640
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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.