L0160 — Cervical, semi-rigid, wire frame occipital/mandibular support, prefabricated, off-the-shelf
L0160 is a HCPCS Level II code for cervical, semi-rigid, wire frame occipital/mandibular support, prefabricated, off-the-shelf. It belongs to the Orthotic and Prosthetic Procedures and Devices section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Medically Unlikely Edits — units per day
The most units of L0160 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
- outpatient
- 1 unit MAI 2 — Date of Service Edit: Policy · Anatomic Consideration
- DME supplier
- 1 unit MAI 2 — Date of Service Edit: Policy · Anatomic Consideration
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for L0160
- Long descriptor
- Cervical, semi-rigid, wire frame occipital/mandibular support, prefabricated, off-the-shelf
- Short descriptor
- Cerv sr wire occ/man pre ots
- Added
- January 1, 1982
- BETOS
- D1F
- Pricing indicator
- 38 — DMEPOS
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Orthotics, prosthetics, prosthetic devices and vision services. Price subject to floors and ceilings.
Codes adjacent to L0160
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If L0160 is not quite right, the correct code is very often within a few positions of it.
- K1036Supplies and accessories (e.g., transducer) for low frequency ultrasonic diathermy treatment device, per month
- K1037Docking station for use with oral device/appliance used to reduce upper airway collapsibility
- L0112Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated
- L0113Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment
- L0120Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar)
- L0130Cervical, flexible, thermoplastic collar, molded to patient
- L0140Cervical, semi-rigid, adjustable (plastic collar)
- L0150Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibular/occipital piece)
- L0170Cervical, collar, molded to patient model
- L0172Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf
- L0174Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf
- L0180Cervical, multiple post collar, occipital/mandibular supports, adjustable
- L0190Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars (somi, guilford, taylor types)
- L0200Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars, and thoracic extension
- L0220Thoracic, rib belt, custom fabricated
- L0450Tlso, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf
Questions about L0160
What is HCPCS code L0160?
L0160 is a HCPCS Level II code for cervical, semi-rigid, wire frame occipital/mandibular support, prefabricated, off-the-shelf. It sits in the Orthotic and Prosthetic Procedures and Devices section.
Does Medicare cover L0160?
The CMS HCPCS file marks L0160 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.