HCPCS code L1810: Knee orthosis, prefabricated (customized)

Yes, L1810 is covered by Medicare under the braces benefit, provided that it is a rigid or semi-rigid device and documentation supports medical necessity. Coverage is subject to the specific requirements of the Local Coverage Determinations (LCDs) and related policy articles from Medicare's Durable Medical Equipment Medicare Administrative Contractors (DME MACs).

No, prior authorization is not required for HCPCS code L1810 under Medicare. However, coverage still depends on meeting all documentation and medical necessity criteria, and some Medicare Advantage or private insurers may impose their own authorization rules.

Documentation must show: ambulatory status; knee weakness or deformity; objective functional assessment; specifics of how the device was customized (e.g., trimming, molding); and include a signed SWO/WOPD prior to delivery.