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HCPCS L7520 · Level II · orthotic and prosthetic code

L7520: Repair prosthetic 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 L7520

Medicare payment
$40.67 to $63.34
DMEPOS non-rural state fees
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
DME supplier MUE
12
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
1 / 1

TL;DR

HCPCS Level II L7520 reads "Repair prosthetic device, labor component, per 15 minutes" in the October 2026 file; it dates from 1997. The October 2026 DMEPOS fee schedule (category LT, labor rates) sets L7520 at $40.67 in AL, AR, CO and 32 more to $63.34 in UT. CMS caps L7520 at DME supplier 12 (MAI 3, Clinical: Data) units per day in the 2026 Q4 MUE tables. 1 active LCD and 1 billing and coding article list L7520 across 7 states: L33787 (Lower Limb Prostheses), A53708. 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). Nearby codes: L7510, L7499, L7406, L7700.

L7520 descriptor and code status

The October 2026 HCPCS Level II file describes L7520 as “Repair prosthetic 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 L7520
FieldValue
Short descriptorRepair prosthesis per 15 min
Added to HCPCS1997-01-01
Last actionN (no maintenance), effective 2000-01-01
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 L7520

The October 2026 DMEPOS fee schedule (category LT, labor rates) sets L7520 at $40.67 in AL, AR, CO and 32 more to $63.34 in UT. 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 J (DME MAC or Part B MAC (joint)), 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 L7520 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
none—$40.67 (AL, AR, CO…) to $63.34 (UT)—AK $50.77, HI $50.77, PR $40.67, VI $40.67

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 L7520

CMS caps L7520 at DME supplier 12 (MAI 3, Clinical: Data) 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 L7520 by setting
SettingMUE (units/DOS)MAICMS rationale
DME supplier123 Date of Service Edit: ClinicalClinical: Data

The MUE lookup for L7520 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists L7520 in v323r0.

L7520 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 L7520 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for L7520

1 active Local Coverage Determination and 1 billing and coding article list L7520. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Billing and Coding Articles listing L7520
ArticleTitleContractor(s)Related LCD
A53708Billing and Coding: External Components for Cochlear ImplantsPalmetto GBA—

Denials to expect on L7520

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists L7520

CARC 151 · N362

units of L7520 exceed the DME supplier MUE of 12 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 L7520 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for L7520 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 L7520

What does HCPCS code L7520 describe?

"Repair prosthetic device, labor component, per 15 minutes" (short descriptor "Repair prosthesis per 15 min"), in the L section (orthotic and prosthetic procedures and devices). Added 1997-01-01; last action N (no maintenance) effective 2000-01-01.

Is L7520 a CPT code?

It is not. L7520 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 L7520?

The October 2026 DMEPOS fee schedule (category LT, labor rates) sets L7520 at $40.67 in AL, AR, CO and 32 more to $63.34 in UT.

How many units of L7520 can be billed per day?

CMS caps L7520 at DME supplier 12 (MAI 3, Clinical: Data) units per day in the 2026 Q4 MUE tables. For the DME supplier MUE (MAI 3), units above 12 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover L7520?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 1 active LCD and 1 billing and coding article list L7520 across 7 states: L33787 (Lower Limb Prostheses), A53708.

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.