L1821 HCPCS code: Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, off the shelf
L1821 is the HCPCS Level II code for knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, off the shelf. The 2026 Medicare DMEPOS fee schedule pays $148.99 to $194.23 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. In 2024, 540 suppliers billed Medicare for L1821 (purchases), serving 5,920 beneficiaries; North Carolina, Pennsylvania, California accounted for 23% of services. Its average fee ranks 5 of 21 L18 codes (family range $74.67–$2,029.02).
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 | 2024-10-01 |
| Last action effective | 2024-10-01 |
2026 Medicare DMEPOS fee schedule for L1821
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $148.99 | $194.23 | $198.66 | $148.99 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $181.64 | — |
| AL | — | $148.99 | — |
| AR | — | $165.33 | — |
| AZ | — | $181.78 | — |
| CA | — | $181.78 | — |
| CO | — | $162.95 | — |
| CT | — | $174.92 | — |
| DC | — | $175.32 | — |
| DE | — | $175.32 | — |
| FL | — | $148.99 | — |
| GA | — | $148.99 | — |
| HI | — | $194.23 | — |
| IA | — | $152.53 | — |
| ID | — | $165.77 | — |
| IL | — | $174.65 | — |
| IN | — | $174.65 | — |
| KS | — | $152.53 | — |
| KY | — | $148.99 | — |
| LA | — | $165.33 | — |
| MA | — | $174.92 | — |
| MD | — | $175.32 | — |
| ME | — | $174.92 | — |
| MI | — | $174.65 | — |
| MN | — | $174.65 | — |
| MO | — | $152.53 | — |
| MS | — | $148.99 | — |
| MT | — | $162.95 | — |
| NC | — | $148.99 | — |
| ND | — | $162.95 | — |
| NE | — | $152.53 | — |
| NH | — | $174.92 | — |
| NJ | — | $169.15 | — |
| NM | — | $165.33 | — |
| NV | — | $181.78 | — |
| NY | — | $169.15 | — |
| OH | — | $174.65 | — |
| OK | — | $165.33 | — |
| OR | — | $165.77 | — |
| PA | — | $175.32 | — |
| PR | — | $173.77 | — |
| RI | — | $174.92 | — |
| SC | — | $148.99 | — |
| SD | — | $162.95 | — |
| TN | — | $148.99 | — |
| TX | — | $165.33 | — |
| UT | — | $162.95 | — |
| VA | — | $175.32 | — |
| VI | — | $169.15 | — |
| VT | — | $174.92 | — |
| WA | — | $165.77 | — |
| WI | — | $174.65 | — |
| WV | — | $175.32 | — |
| WY | — | $162.95 | — |
How the L1821 fee compares
| Measure | Value |
|---|---|
| Rank among 21 L18 codes (lowest = 1) | 5 |
| Family fee range (average of state fees) | $74.67–$2,029.02 |
| Rural fee uplift | — |
Who bills L1821 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 540 |
| Referring clinicians | 3,353 |
| Medicare beneficiaries | 5,920 |
| States with claims | 44 |
| Share of services in top 3 states (North Carolina, Pennsylvania, California) | 23% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L1821, 2024–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2024 | 6,204 | 5,920 | $157.12 | $121.96 |
States with the most L1821 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| North Carolina | 598 | $110.46 |
| Pennsylvania | 440 | $130.08 |
| California | 394 | $131.68 |
| Maryland | 357 | $130.46 |
| Florida | 337 | $112.66 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 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 L1821
- 2026-01-01: Average state fee rose 2.0%: $163.81 to $167.08
- 2024-10-01: L1821 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 L1821?
L1821 is the HCPCS Level II code for knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, off the shelf. Short descriptor: "Ko elas w/ condyle pads otf".
How much does Medicare pay for L1821?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $148.99–$194.23. Rural fees can be higher.
Does Medicare cover L1821?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for L1821?
Medicare policy articles that cite L1821 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 L1821 change in 2026?
The average non-rural state fee moved from $163.81 in 2025 to $167.08 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L1821 can be billed per day?
2 on DME suppliers (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)
- L1812 — Knee orthosis, elastic with joints, prefabricated, off-the-shelf ($70.12–$126.23)
- 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)
- 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 L1821
- Watch L1821 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L1821
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.