L4000 HCPCS code: Replace girdle for spinal orthosis (ctlso or so)
L4000 is the HCPCS Level II code for replace girdle for spinal orthosis (ctlso or so). The 2026 Medicare DMEPOS fee schedule pays $1,332.49 to $2,202.71 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 12 of 12 L40 codes (family range $117.32–$1,638.51).
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 | 1985-01-01 |
| Last action effective | 2002-01-01 |
2026 Medicare DMEPOS fee schedule for L4000
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $1,332.49 | $2,202.71 | $1,953.57 | $1,465.18 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $2,059.93 | — |
| AL | — | $1,499.07 | — |
| AR | — | $1,548.39 | — |
| AZ | — | $1,953.57 | — |
| CA | — | $1,953.57 | — |
| CO | — | $1,661.67 | — |
| CT | — | $1,756.27 | — |
| DC | — | $1,581.89 | — |
| DE | — | $1,581.89 | — |
| FL | — | $1,499.07 | — |
| GA | — | $1,499.07 | — |
| HI | — | $2,202.71 | — |
| IA | — | $1,629.74 | — |
| ID | — | $1,664.53 | — |
| IL | — | $1,623.97 | — |
| IN | — | $1,623.97 | — |
| KS | — | $1,629.74 | — |
| KY | — | $1,499.07 | — |
| LA | — | $1,548.39 | — |
| MA | — | $1,756.27 | — |
| MD | — | $1,581.89 | — |
| ME | — | $1,756.27 | — |
| MI | — | $1,623.97 | — |
| MN | — | $1,623.97 | — |
| MO | — | $1,629.74 | — |
| MS | — | $1,499.07 | — |
| MT | — | $1,661.67 | — |
| NC | — | $1,499.07 | — |
| ND | — | $1,661.67 | — |
| NE | — | $1,629.74 | — |
| NH | — | $1,756.27 | — |
| NJ | — | $1,465.18 | — |
| NM | — | $1,548.39 | — |
| NV | — | $1,953.57 | — |
| NY | — | $1,465.18 | — |
| OH | — | $1,623.97 | — |
| OK | — | $1,548.39 | — |
| OR | — | $1,664.53 | — |
| PA | — | $1,581.89 | — |
| PR | — | $1,332.49 | — |
| RI | — | $1,756.27 | — |
| SC | — | $1,499.07 | — |
| SD | — | $1,661.67 | — |
| TN | — | $1,499.07 | — |
| TX | — | $1,548.39 | — |
| UT | — | $1,661.67 | — |
| VA | — | $1,581.89 | — |
| VI | — | $1,465.18 | — |
| VT | — | $1,756.27 | — |
| WA | — | $1,664.53 | — |
| WI | — | $1,623.97 | — |
| WV | — | $1,581.89 | — |
| WY | — | $1,661.67 | — |
How the L4000 fee compares
| Measure | Value |
|---|---|
| Rank among 12 L40 codes (lowest = 1) | 12 |
| Family fee range (average of state fees) | $117.32–$1,638.51 |
| 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 L4000
- 2026-01-01: Average state fee rose 2.0%: $1,606.39 to $1,638.51
- 1985-01-01: L4000 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 L4000?
L4000 is the HCPCS Level II code for replace girdle for spinal orthosis (ctlso or so). Short descriptor: "Repl girdle milwaukee orth".
How much does Medicare pay for L4000?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $1,332.49–$2,202.71. Rural fees can be higher.
Does Medicare cover L4000?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L4000 change in 2026?
The average non-rural state fee moved from $1,606.39 in 2025 to $1,638.51 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L4000 can be billed per day?
1 on DME suppliers; 1 on outpatient hospital claims (NCCI medically unlikely edits).
Related L40 codes
- L4002 — Replacement strap, any orthosis, includes all components, any length, any type
- L4010 — Replace trilateral socket brim ($771.19–$1,290.07)
- L4020 — Replace quadrilateral socket brim, molded to patient model ($989.77–$1,433.34)
- L4030 — Replace quadrilateral socket brim, custom fitted ($580.17–$1,142.13)
- L4040 — Replace molded thigh lacer, for custom fabricated orthosis only ($469.07–$1,370.51)
- L4045 — Replace non-molded thigh lacer, for custom fabricated orthosis only ($376.94–$738.06)
- L4050 — Replace molded calf lacer, for custom fabricated orthosis only ($474.40–$1,142.13)
- L4055 — Replace non-molded calf lacer, for custom fabricated orthosis only ($307.20–$686.22)
- L4060 — Replace high roll cuff ($304.58–$689.86)
- L4070 — Replace proximal and distal upright for kafo ($304.58–$949.20)
- L4080 — Replace metal bands kafo, proximal thigh ($116.23–$154.98)
- L4090 — Replace metal bands kafo-afo, calf or distal thigh ($103.77–$142.76)
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Next steps
- Run a reimbursement report for a device billed under L4000
- Watch L4000 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L4000
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.