L89.123: Pressure ulcer of left upper back, stage 3
L89.123, pressure ulcer of left upper back, stage 3, is listed as a covered diagnosis in 6 Medicare billing and coding articles that apply to 19 HCPCS Level II codes, including E0194 (Air fluidized bed), E0193 (Powered air flotation bed (low air loss therapy)), E0373 (Nonpowered advanced pressure reducing mattress). 7 of these codes have a 2026 DMEPOS fee schedule amount; E0194 pays $3,856.78 to $4,884.31 (RR) depending on the state. The articles come from 3 Medicare contractors. A listed diagnosis supports medical necessity only; coverage still depends on the LCD's criteria and on documentation in the medical record.
HCPCS Level II codes with L89.123 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| E0194 | Air fluidized bed | Special coverage instructions apply | $3,856.78–$4,884.31 (RR) | 1 |
| E0193 | Powered air flotation bed (low air loss therapy) | Carrier judgment | $837.96–$1,189.47 (RR) | 1 |
| E0373 | Nonpowered advanced pressure reducing mattress | Carrier judgment | $185.56–$576.49 (RR) | 1 |
| E0277 | Powered pressure-reducing air mattress | Special coverage instructions apply | $185.56–$563.59 (RR) | 1 |
| E0372 | Powered air overlay for mattress, standard mattress length and width | Carrier judgment | $185.56–$519.97 (RR) | 1 |
| E0371 | Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width | Carrier judgment | $185.56–$451.50 (RR) | 1 |
| E0181 | Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty | Special coverage instructions apply | $17.94–$36.69 (RR) | 1 |
| E1399 | Durable medical equipment, miscellaneous | Carrier judgment | — | 1 |
| G0281 | Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care | Carrier judgment | — | 3 |
| G0329 | Electromagnetic therapy, to one or more areas for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care | Carrier judgment | — | 3 |
| G0283 | Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care | Carrier judgment | — | 3 |
| G0152 | Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes | Carrier judgment | — | 1 |
| G0158 | Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes | Carrier judgment | — | 1 |
| G0160 | Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutes | Carrier judgment | — | 1 |
| G2169 | Services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes | Carrier judgment | — | 1 |
| G2010 | Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment | Carrier judgment | — | 1 |
| G2250 | Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment | Carrier judgment | — | 1 |
| G2251 | Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion | Carrier judgment | — | 1 |
| G0151 | Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes | Carrier judgment | — | 1 |
Medicare policy articles listing L89.123
- A52468: Pressure Reducing Support Surfaces - Group 3- Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC); 1 Level II codes). LCD with the same title: L33692
- A52490: Pressure Reducing Support Surfaces - Group 2 - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC); 7 Level II codes). LCD with the same title: L33642
- A55909: Billing and Coding: Wound Care (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L35125, L37166, L37228
- A53057: Billing and Coding: Home Health Occupational Therapy (Palmetto GBA (HHH MAC); 5 Level II codes). LCD with the same title: L34560
- A53064: Billing and Coding: Outpatient Occupational Therapy (Palmetto GBA (MAC - Part A); 3 Level II codes). LCD with the same title: L34427
- A57311: Billing and Coding: Physical Therapy - Home Health (CGS Administrators, LLC (HHH MAC); 7 Level II codes). LCD with the same title: L33942
A diagnosis listed as covered in a billing and coding article supports medical necessity for the article's codes; it does not guarantee payment. Coverage depends on the LCD's criteria, the contractor's jurisdiction and documentation in the medical record.
Other L89 diagnoses (Pressure ulcer)
- L89.120 — Pressure ulcer of left upper back, unstageable
- L89.121 — Pressure ulcer of left upper back, stage 1
- L89.122 — Pressure ulcer of left upper back, stage 2
- L89.124 — Pressure ulcer of left upper back, stage 4
- L89.126 — Pressure-induced deep tissue damage of left upper back
- L89.103 — Pressure ulcer of unspecified part of back, stage 3
- L89.104 — Pressure ulcer of unspecified part of back, stage 4
- L89.106 — Pressure-induced deep tissue damage of unspecified part of back
- L89.110 — Pressure ulcer of right upper back, unstageable
- L89.111 — Pressure ulcer of right upper back, stage 1
- L89.112 — Pressure ulcer of right upper back, stage 2
- L89.113 — Pressure ulcer of right upper back, stage 3
- L89.114 — Pressure ulcer of right upper back, stage 4
- L89.116 — Pressure-induced deep tissue damage of right upper back
- L89.130 — Pressure ulcer of right lower back, unstageable
- L89.131 — Pressure ulcer of right lower back, stage 1
- L89.132 — Pressure ulcer of right lower back, stage 2
- L89.133 — Pressure ulcer of right lower back, stage 3
- L89.134 — Pressure ulcer of right lower back, stage 4
- L89.136 — Pressure-induced deep tissue damage of right lower back
- L89.140 — Pressure ulcer of left lower back, unstageable
- L89.141 — Pressure ulcer of left lower back, stage 1
- L89.142 — Pressure ulcer of left lower back, stage 2
- L89.143 — Pressure ulcer of left lower back, stage 3
- L89.144 — Pressure ulcer of left lower back, stage 4
- L89.146 — Pressure-induced deep tissue damage of left lower back
- L89.150 — Pressure ulcer of sacral region, unstageable
- L89.151 — Pressure ulcer of sacral region, stage 1
- L89.152 — Pressure ulcer of sacral region, stage 2
- L89.153 — Pressure ulcer of sacral region, stage 3
Frequently asked questions
Does Medicare cover L89.123 (Pressure ulcer of left upper back, stage 3)?
Medicare covers items and services, not diagnoses. 6 Medicare billing and coding articles list L89.123 as a covered diagnosis for 19 HCPCS Level II codes: the diagnosis can support medical necessity for those codes, but payment still depends on the LCD's coverage criteria and the medical record.
Which HCPCS codes can be billed with ICD-10 L89.123?
The Level II codes from the policies most specific to this diagnosis are E0194 (Air fluidized bed, 1 article); E0193 (Powered air flotation bed (low air loss therapy), 1 article); E0373 (Nonpowered advanced pressure reducing mattress, 1 article); E0277 (Powered pressure-reducing air mattress, 1 article); E0372 (Powered air overlay for mattress, standard mattress length…, 1 article). Code choice depends on the item supplied; check each code's descriptor.
What does Medicare pay for equipment billed with L89.123?
Under the 2026 DMEPOS fee schedule (non-rural state fees): E0194 $3,856.78 to $4,884.31 (RR); E0193 $837.96 to $1,189.47 (RR); E0373 $185.56 to $576.49 (RR); E0277 $185.56 to $563.59 (RR). Medicare pays 80% of the allowed amount after the Part B deductible.
Which Medicare policy articles list L89.123?
A52468 (Pressure Reducing Support Surfaces - Group 3- Policy Article); A52490 (Pressure Reducing Support Surfaces - Group 2 - Policy Article); A55909 (Billing and Coding: Wound Care), and 3 more articles.
What is ICD-10-CM code L89.123?
L89.123 is the ICD-10-CM code for pressure ulcer of left upper back, stage 3, in category L89 (Pressure ulcer), chapter 12: Diseases of the skin and subcutaneous tissue.
Next steps
- Run a reimbursement report for a device billed under E0194
- Watch E0194 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for E0194
Sources: CMS Medicare Coverage Database billing and coding articles (covered ICD-10 code lists and HCPCS links); ICD-10-CM FY2026; CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026 (non-rural state fees). Not billing or legal advice.
Chapter 12: Diseases of the skin and subcutaneous tissue · All diagnoses · HCPCS lookup