L1040 — Addition to ctlso or scoliosis orthosis, lumbar or lumbar rib pad
L1040 is a HCPCS Level II code for addition to ctlso or scoliosis orthosis, lumbar or lumbar rib pad. 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 L1040 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 3 — Date of Service Edit: Clinical · Nature of Equipment
- DME supplier
- 1 unit MAI 3 — Date of Service Edit: Clinical · Nature of Equipment
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 L1040
- Long descriptor
- Addition to ctlso or scoliosis orthosis, lumbar or lumbar rib pad
- Short descriptor
- Lumbar or lumbar rib pad
- Added
- January 1, 1986
- 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 L1040
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If L1040 is not quite right, the correct code is very often within a few positions of it.
- L1001Cervical thoracic lumbar sacral orthosis, immobilizer, infant size, prefabricated, includes fitting and adjustment
- L1005Tension based scoliosis orthosis and accessory pads, includes fitting and adjustment
- L1006Scoliosis orthosis, sagittal-coronal control provided by a rigid lateral frame, extends from axilla to trochanter, includes all accessory pads, straps and interface, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
- L1007Scoliosis orthosis, sagittal-coronal control provided by a rigid lateral frame, extends from axilla, to trochanter, includes all accessory pads, straps, and interface, custom fabricated
- L1010Addition to cervical-thoracic-lumbar-sacral orthosis (ctlso) or scoliosis orthosis, axilla sling
- L1020Addition to ctlso or scoliosis orthosis, kyphosis pad
- L1025Addition to ctlso or scoliosis orthosis, kyphosis pad, floating
- L1030Addition to ctlso or scoliosis orthosis, lumbar bolster pad
- L1050Addition to ctlso or scoliosis orthosis, sternal pad
- L1060Addition to ctlso or scoliosis orthosis, thoracic pad
- L1070Addition to ctlso or scoliosis orthosis, trapezius sling
- L1080Addition to ctlso or scoliosis orthosis, outrigger
- L1085Addition to ctlso or scoliosis orthosis, outrigger, bilateral with vertical extensions
- L1090Addition to ctlso or scoliosis orthosis, lumbar sling
- L1100Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather
- L1110Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather, molded to patient model
Questions about L1040
What is HCPCS code L1040?
L1040 is a HCPCS Level II code for addition to ctlso or scoliosis orthosis, lumbar or lumbar rib pad. It sits in the Orthotic and Prosthetic Procedures and Devices section.
Does Medicare cover L1040?
The CMS HCPCS file marks L1040 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.