L1812 HCPCS code: Knee orthosis, elastic with joints, prefabricated, off-the-shelf
L1812 is the HCPCS Level II code for knee orthosis, elastic with joints, prefabricated, off-the-shelf. The 2026 Medicare DMEPOS fee schedule pays $70.12 to $126.23 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 2 per day on DME suppliers. Medicare volume rose 14% from 2022 to 2024 (28,714 to 32,673 services). In 2024, 1,938 suppliers billed Medicare for L1812 (purchases), serving 30,399 beneficiaries; California, Ohio, Virginia accounted for 20% of services. Its average fee ranks 2 of 21 L18 codes (family range $74.67–$2,029.02); rural fees run 31% higher.
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 | 2014-01-01 |
| Last action effective | 2014-01-01 |
2026 Medicare DMEPOS fee schedule for L1812
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $70.12 | $126.23 | — | — |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $120.79 | — |
| AL | — | $85.71 | $117.65 |
| AR | — | $85.71 | $104.31 |
| AZ | — | $70.12 | $117.50 |
| CA | — | $70.12 | $117.50 |
| CO | — | $71.44 | $100.86 |
| CT | — | $83.00 | $102.25 |
| DC | — | $77.63 | $99.44 |
| DE | — | $77.63 | $99.44 |
| FL | — | $85.71 | $117.65 |
| GA | — | $85.71 | $117.65 |
| HI | — | $126.23 | — |
| IA | — | $77.34 | $100.36 |
| ID | — | $71.44 | $108.36 |
| IL | — | $78.51 | $106.11 |
| IN | — | $78.51 | $106.11 |
| KS | — | $77.34 | $100.36 |
| KY | — | $85.71 | $117.65 |
| LA | — | $85.71 | $104.31 |
| MA | — | $83.00 | $102.25 |
| MD | — | $77.63 | $99.44 |
| ME | — | $83.00 | $102.25 |
| MI | — | $78.51 | $106.11 |
| MN | — | $77.34 | $106.11 |
| MO | — | $77.34 | $100.36 |
| MS | — | $85.71 | $117.65 |
| MT | — | $71.44 | $100.86 |
| NC | — | $85.71 | $117.65 |
| ND | — | $77.34 | $100.86 |
| NE | — | $77.34 | $100.36 |
| NH | — | $83.00 | $102.25 |
| NJ | — | $77.63 | $104.58 |
| NM | — | $70.12 | $104.31 |
| NV | — | $70.12 | $117.50 |
| NY | — | $77.63 | $104.58 |
| OH | — | $78.51 | $106.11 |
| OK | — | $70.12 | $104.31 |
| OR | — | $70.12 | $108.36 |
| PA | — | $77.63 | $99.44 |
| PR | — | $110.52 | — |
| RI | — | $83.00 | $102.25 |
| SC | — | $85.71 | $117.65 |
| SD | — | $77.34 | $100.86 |
| TN | — | $85.71 | $117.65 |
| TX | — | $70.12 | $104.31 |
| UT | — | $71.44 | $100.86 |
| VA | — | $85.71 | $99.44 |
| VI | — | $104.58 | — |
| VT | — | $83.00 | $102.25 |
| WA | — | $70.12 | $108.36 |
| WI | — | $78.51 | $106.11 |
| WV | — | $85.71 | $99.44 |
| WY | — | $71.44 | $100.86 |
How the L1812 fee compares
| Measure | Value |
|---|---|
| Rank among 21 L18 codes (lowest = 1) | 2 |
| Family fee range (average of state fees) | $74.67–$2,029.02 |
| Rural fee uplift | 30.7% |
Who bills L1812 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 1,938 |
| Referring clinicians | 10,564 |
| Medicare beneficiaries | 30,399 |
| States with claims | 51 |
| Share of services in top 3 states (California, Ohio, Virginia) | 20% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 1,879 | 27,077 |
| 2023 | 1,803 | 27,055 |
| 2024 | 1,938 | 30,399 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L1812, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 28,714 | 27,077 | $81.88 | $61.84 |
| 2023 | 28,759 | 27,055 | $82.92 | $62.22 |
| 2024 | 32,673 | 30,399 | $78.95 | $58.61 |
States with the most L1812 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 2,541 | $44.38 |
| Ohio | 2,286 | $60.28 |
| Virginia | 1,844 | $51.08 |
| Pennsylvania | 1,696 | $54.74 |
| Georgia | 1,564 | $76.04 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 2 | Anatomic Consideration |
| outpatient hospital claims | 2 | Anatomic Consideration |
Medicare policy articles for this code
- A52465: Knee Orthoses - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (4,806 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| G04.1 | Tropical spastic paraplegia | 1 |
| G35.A | Relapsing-remitting multiple sclerosis | 1 |
| G35.B0 | Primary progressive multiple sclerosis, unspecified | 1 |
| G35.B1 | Active primary progressive multiple sclerosis | 1 |
| G35.B2 | Non-active primary progressive multiple sclerosis | 1 |
| G35.C0 | Secondary progressive multiple sclerosis, unspecified | 1 |
| G35.C1 | Active secondary progressive multiple sclerosis | 1 |
| G35.C2 | Non-active secondary progressive multiple sclerosis | 1 |
| G35.D | Multiple sclerosis, unspecified | 1 |
| G57.01 | Lesion of sciatic nerve, right lower limb | 1 |
Showing 10 of 4,806. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for L1812
- 2026-01-01: Average state fee rose 2.7%: $79.16 to $81.25
- 2014-01-01: L1812 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 L1812?
L1812 is the HCPCS Level II code for knee orthosis, elastic with joints, prefabricated, off-the-shelf. Short descriptor: "Ko elastic w/joints pre ots".
How much does Medicare pay for L1812?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $70.12–$126.23. Rural fees can be higher.
Does Medicare cover L1812?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for L1812?
Medicare policy articles that cite L1812 list 4,806 covered ICD-10-CM diagnosis codes across 1 article. The most cited include G04.1 (Tropical spastic paraplegia), G35.A (Relapsing-remitting multiple sclerosis), G35.B0 (Primary progressive multiple sclerosis, unspecified). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
Did the Medicare fee for L1812 change in 2026?
The average non-rural state fee moved from $79.16 in 2025 to $81.25 in 2026 (+2.7%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L1812 can be billed per day?
2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).
Related L18 codes
- L1810 — Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise ($113.17–$166.75)
- L1820 — Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise ($148.99–$194.23)
- L1821 — Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, off the shelf ($148.99–$194.23)
- L1830 — Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf ($63.18–$149.93)
- L1831 — Knee orthosis, locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment ($353.04–$388.33)
- L1832 — Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise ($698.63–$1,618.03)
- L1833 — Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf ($455.16–$1,087.16)
- L1834 — Knee orthosis, without knee joint, rigid, custom fabricated ($892.02–$1,808.36)
- L1836 — Knee orthosis, rigid, without joint(s), includes soft interface material, prefabricated, off-the-shelf ($89.34–$142.64)
- L1840 — Knee orthosis, derotation, medial-lateral, anterior cruciate ligament, custom fabricated ($1,056.60–$1,606.15)
- L1843 — Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise ($1,076.26–$1,183.90)
- L1844 — Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated ($1,865.51–$2,436.24)
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 L1812
- Watch L1812 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L1812
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.