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HCPCS L1007 · Level II · orthotic and prosthetic code

L1007: Scoliosis orthosis, sagittal-coronal control provided by a rigid lateral frame, HCPCS Level II orthotic and prosthetic code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update).

Key facts for L1007

Medicare payment
paid outside OPPS
OPPS SI A: another fee schedule or payment system
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
DME supplier MUE
1
MAI 2
OPPS status
SI A
Services not paid under OPPS; paid under fee schedule or other payment system
NCCI PTP pairs
0
practitioner file
LCDs and articles
0 / 0

TL;DR

HCPCS Level II L1007 reads "Scoliosis orthosis, sagittal-coronal control provided by a rigid lateral frame, extends from axilla, to trochanter, includes all accessory pads, straps, and interface, custom fabricated" in the October 2026 file; it dates from 2025. None of the October 2026 PFS, DMEPOS, CLFS, OPPS or ASC files lists a national amount for L1007; its HCPCS pricing indicator is 46 (DMEPOS contractor-priced (not otherwise classified, individual determination or gap-filled)). Its OPPS status indicator is A, which the I/OCE table defines as "Services not paid under OPPS; paid under fee schedule or other payment system": Medicare pays L1007 under a fee schedule or payment system other than OPPS. CMS caps L1007 at DME supplier 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. No current LCD or billing article lists L1007; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage). HCPCS record: BETOS D1F (prosthetic/orthotic devices); pricing indicator 46; type of service P (lump-sum purchase of DME, prosthetics or orthotics). 1 other active code opens with "Scoliosis orthosis"; related codes: L1006, L1005, L1010, L1001.

L1007 descriptor and code status

The October 2026 HCPCS Level II file describes L1007 as “Scoliosis orthosis, sagittal-coronal control provided by a rigid lateral frame, extends from axilla, to trochanter, includes all accessory pads, straps, and interface, custom fabricated”. It sits in the L section (orthotic and prosthetic procedures and devices), listed with the other L codes.

HCPCS file attributes of L1007
FieldValue
Short descriptorScoliosis orth s-c custom
Added to HCPCS2025-10-01
Last actionN (no maintenance), effective 2025-10-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator46: DMEPOS contractor-priced (not otherwise classified, individual determination or gap-filled)
BETOS categoryD1F: prosthetic/orthotic devices
Type of serviceP: lump-sum purchase of DME, prosthetics or orthotics

Medicare payment for L1007

None of the October 2026 PFS, DMEPOS, CLFS, OPPS or ASC files lists a national amount for L1007; its HCPCS pricing indicator is 46 (DMEPOS contractor-priced (not otherwise classified, individual determination or gap-filled)). Its OPPS status indicator is A, which the I/OCE table defines as "Services not paid under OPPS; paid under fee schedule or other payment system": Medicare pays L1007 under a fee schedule or payment system other than OPPS. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Hospital outpatient (OPPS Addendum B)

Status indicator A (Services not paid under OPPS; paid under fee schedule or other payment system), with no separate OPPS payment rate.

Medically Unlikely Edits for L1007

CMS caps L1007 at DME supplier 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. The DME supplier MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.

MUE values for L1007 by setting
SettingMUE (units/DOS)MAICMS rationale
DME supplier12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction

The MUE lookup for L1007 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists L1007 in v323r0.

L1007 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check L1007 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for L1007

No current LCD or billing and coding article lists L1007. The HCPCS coverage code C means carrier judgment, so the Medicare contractor decides coverage, and any National Coverage Determination for the service still applies.

Denials to expect on L1007

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units of L1007 exceed the DME supplier MUE of 1 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks the description, invoice or pricing detail a contractor-priced code needs

Where QuickIntell fits for L1007 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for L1007 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS L1007

What does HCPCS code L1007 describe?

"Scoliosis orthosis, sagittal-coronal control provided by a rigid lateral frame, extends from axilla, to trochanter, includes all accessory pads, straps, and interface, custom fabricated" (short descriptor "Scoliosis orth s-c custom"), in the L section (orthotic and prosthetic procedures and devices). Added 2025-10-01.

Is L1007 a CPT code?

It is not. L1007 belongs to the L section (orthotic and prosthetic procedures and devices) of HCPCS Level II, the CMS code set, not to AMA CPT.

What does Medicare pay for L1007?

None of the October 2026 PFS, DMEPOS, CLFS, OPPS or ASC files lists a national amount for L1007; its HCPCS pricing indicator is 46 (DMEPOS contractor-priced (not otherwise classified, individual determination or gap-filled)). Its OPPS status indicator is A, which the I/OCE table defines as "Services not paid under OPPS; paid under fee schedule or other payment system": Medicare pays L1007 under a fee schedule or payment system other than OPPS.

How many units of L1007 can be billed per day?

CMS caps L1007 at DME supplier 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. For the DME supplier MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover L1007?

No current LCD or billing article lists L1007; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.