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HCPCS L4205 · Level II · orthotic and prosthetic code

L4205: Repair of orthotic device, labor component, per 15 minutes, 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); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and DMEPOS fee schedule and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for L4205

Medicare payment
$29.92 to $49.16
DMEPOS non-rural state fees
Coverage code
D
special coverage instructions apply
DME supplier MUE
8
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
2 / 0

TL;DR

HCPCS Level II L4205 reads "Repair of orthotic device, labor component, per 15 minutes" in the October 2026 file; it dates from 1997. L4205 is paid from the DMEPOS fee schedule as labor rates (LT): $29.92 in AZ, DC, DE and 24 more to $49.16 in CA, October 2026. MUE limits for L4205: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 8 (MAI 3, Clinical: Data); DME supplier 8 (MAI 3, Clinical: Data). 2 active LCDs list L4205: L33318 (Knee Orthoses), L33686 (Ankle-Foot/Knee-Ankle-Foot Orthosis). 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 46; type of service P (lump-sum purchase of DME, prosthetics or orthotics). 1 other active code opens with "Repair of orthotic device"; related codes: L4210, L4060, L4350, L4050.

L4205 descriptor and code status

The October 2026 HCPCS Level II file describes L4205 as “Repair of orthotic device, labor component, per 15 minutes”. It sits in the L section (orthotic and prosthetic procedures and devices), listed with the other L codes.

HCPCS file attributes of L4205
FieldValue
Short descriptorOrtho dvc repair per 15 min
Added to HCPCS1997-01-01
Last actionN (no maintenance), effective 1997-01-01
Coverage codeD: special coverage instructions apply
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 L4205

L4205 is paid from the DMEPOS fee schedule as labor rates (LT): $29.92 in AZ, DC, DE and 24 more to $49.16 in CA, October 2026. 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 LT (labor rates). 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 L4205 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
none—$29.92 (AZ, DC, DE…) to $49.16 (CA)—AK $43.15, HI $43.15, PR $29.95, VI $29.95

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 L4205

MUE limits for L4205: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 8 (MAI 3, Clinical: Data); DME supplier 8 (MAI 3, Clinical: Data). 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 L4205 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital83 Date of Service Edit: ClinicalClinical: Data
DME supplier83 Date of Service Edit: ClinicalClinical: Data

The MUE lookup for L4205 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists L4205 in v323r0.

L4205 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 L4205 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for L4205

2 active Local Coverage Determinations and 0 billing and coding articles list L4205. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Denials to expect on L4205

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists L4205

CARC 151 · N362

units of L4205 exceed the DME supplier MUE of 8 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 L4205 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for L4205 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 L4205

What does HCPCS code L4205 describe?

"Repair of orthotic device, labor component, per 15 minutes" (short descriptor "Ortho dvc repair per 15 min"), in the L section (orthotic and prosthetic procedures and devices). Added 1997-01-01.

Is L4205 a CPT code?

No: CMS maintains L4205 in HCPCS Level II, while the AMA maintains CPT. It goes in the same procedure-code field.

What does Medicare pay for L4205?

L4205 is paid from the DMEPOS fee schedule as labor rates (LT): $29.92 in AZ, DC, DE and 24 more to $49.16 in CA, October 2026.

How many units of L4205 can be billed per day?

MUE limits for L4205: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 8 (MAI 3, Clinical: Data); DME supplier 8 (MAI 3, Clinical: Data). For the DME supplier MUE (MAI 3), units above 8 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover L4205?

Coverage code D (special coverage instructions apply). 2 active LCDs list L4205: L33318 (Knee Orthoses), L33686 (Ankle-Foot/Knee-Ankle-Foot Orthosis).

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.