L4205 HCPCS code: Repair of orthotic device, labor component, per 15 minutes

L4205 is the HCPCS Level II code for repair of orthotic device, labor component, per 15 minutes. The 2026 Medicare DMEPOS fee schedule pays $29.92 to $49.16 depending on the state. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 8 per day on DME suppliers. Medicare volume fell 16% from 2022 to 2024 (23,799 to 20,052 services). In 2024, 909 suppliers billed Medicare for L4205 (purchases), serving 5,074 beneficiaries; New York, Massachusetts, California accounted for 35% of services.

Code details

2026 Medicare DMEPOS fee schedule for L4205

How the L4205 fee compares

Who bills L4205 (2024)

Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.

Medicare utilization for L4205, 2022–2024

States with the most L4205 services (2024)

NCCI unit limits (MUE)

Medicare policy articles for this code

• A52457: Ankle-Foot/Knee-Ankle-Foot Orthoses - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
• 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 (4,818 ICD-10-CM codes)

The diagnoses most often listed as covered in the policy articles above:

Showing 10 of 4,818. The full list, non-covered diagnoses and CSV export are in Caduvo.

What changed for L4205

• 1997-01-01: L4205 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 L4205?

L4205 is the HCPCS Level II code for repair of orthotic device, labor component, per 15 minutes. Short descriptor: "Ortho dvc repair per 15 min".

How much does Medicare pay for L4205?

Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $29.92–$49.16. Rural fees can be higher.

Does Medicare cover L4205?

Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.

Which diagnoses support coverage for L4205?

Medicare policy articles that cite L4205 list 4,818 covered ICD-10-CM diagnosis codes across 2 articles. The most cited include A52.16 (Charcot's arthropathy (tabetic)), E08.610 (Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy), E09.610 (Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.

How many units of L4205 can be billed per day?

8 on DME suppliers; 8 on outpatient hospital claims (NCCI medically unlikely edits).

Related L42 codes

• L4210 — Repair of orthotic device, repair or replace minor parts

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Next steps

• Run a reimbursement report for a device billed under L4205
• Watch L4205 for fee, coverage and descriptor changes
• Build a full Medicare revenue model for L4205

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.

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