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HCPCS L1280 · Level II · orthotic and prosthetic code

L1280: Addition to TLSO, (low profile), rib gusset (elastic), each, 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); DMEPOS fee schedule: DME26-D (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 L1280

Medicare payment
$99.14 to $132.18
DMEPOS non-rural state fees
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
DME supplier MUE
2
MAI 3
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 L1280 reads "Addition to tlso, (low profile), rib gusset (elastic), each" in the October 2026 file; it dates from 1988. The October 2026 DMEPOS fee schedule (category PO, prosthetics and orthotics) sets L1280 at $99.14 in AR, CO, IA and 12 more to $132.18 in AZ, CA, CT and 6 more (floor $99.14, ceiling $132.18). CMS caps L1280 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 3, Nature of Equipment); DME supplier 2 (MAI 3, Nature of Equipment) units per day in the 2026 Q4 MUE tables. L1280 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code C (carrier judgment, so the Medicare contractor decides coverage) and any NCD. OPPS status indicator A: Services not paid under OPPS; paid under fee schedule or other payment system. HCPCS record: BETOS D1F (prosthetic/orthotic devices); pricing indicator 38; type of service P (lump-sum purchase of DME, prosthetics or orthotics). 8 other active codes open with "Addition to tlso"; related codes: L1250, L1220, L1210, L1270.

L1280 descriptor and code status

The October 2026 HCPCS Level II file describes L1280 as “Addition to tlso, (low profile), rib gusset (elastic), each”. It sits in the L section (orthotic and prosthetic procedures and devices), listed with the other L codes.

HCPCS file attributes of L1280
FieldValue
Short descriptorRib gusset (elastic) each
Added to HCPCS1988-01-01
Last actionN (no maintenance), effective 1996-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator38: DMEPOS orthotics, prosthetics, prosthetic devices and vision services (floors and ceilings)
BETOS categoryD1F: prosthetic/orthotic devices
Type of serviceP: lump-sum purchase of DME, prosthetics or orthotics

Medicare payment for L1280

The October 2026 DMEPOS fee schedule (category PO, prosthetics and orthotics) sets L1280 at $99.14 in AR, CO, IA and 12 more to $132.18 in AZ, CA, CT and 6 more (floor $99.14, ceiling $132.18). 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.

DMEPOS fee schedule (DME26-D)

Jurisdiction D (DME MAC), payment category PO (prosthetics and orthotics). Fees are set per state; AK, HI, PR and VI are not subject to the national ceiling and floor and are listed separately. A rural fee applies only in ZIP codes on the CMS rural ZIP list.

DMEPOS fees for L1280 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
none$99.14 / $132.18$99.14 (AR, CO, IA…) to $132.18 (AZ, CA, CT…)—AK $156.25, HI $167.07, PR $102.60, VI $106.49

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 L1280

CMS caps L1280 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 3, Nature of Equipment); DME supplier 2 (MAI 3, Nature of Equipment) units per day in the 2026 Q4 MUE tables. The DME supplier MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for L1280 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital23 Date of Service Edit: ClinicalNature of Equipment
DME supplier23 Date of Service Edit: ClinicalNature of Equipment

The MUE lookup for L1280 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists L1280 in v323r0.

L1280 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 L1280 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for L1280

No current LCD or billing and coding article lists L1280. 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 L1280

CARC 50 · N115

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

CARC 151 · N362

units of L1280 exceed the DME supplier MUE of 2 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for L1280 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for L1280 depend on, with human review of each case, and QuickRCM carries claim readiness and the CARC 50, 151 and modifier denials these items draw.

See QuickAuth for requirement checksSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS L1280

What does HCPCS code L1280 describe?

"Addition to tlso, (low profile), rib gusset (elastic), each" (short descriptor "Rib gusset (elastic) each"), in the L section (orthotic and prosthetic procedures and devices). Added 1988-01-01; last action N (no maintenance) effective 1996-01-01.

Is L1280 a CPT code?

It is not. L1280 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 L1280?

The October 2026 DMEPOS fee schedule (category PO, prosthetics and orthotics) sets L1280 at $99.14 in AR, CO, IA and 12 more to $132.18 in AZ, CA, CT and 6 more (floor $99.14, ceiling $132.18).

How many units of L1280 can be billed per day?

CMS caps L1280 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 3, Nature of Equipment); DME supplier 2 (MAI 3, Nature of Equipment) units per day in the 2026 Q4 MUE tables. For the DME supplier MUE (MAI 3), units above 2 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover L1280?

L1280 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code C (carrier judgment, so the Medicare contractor decides coverage) and any NCD.

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.