L5000 — Partial foot, shoe insert with longitudinal arch, toe filler
HCPCS Level II L-code · short descriptor: “Sho insert w arch toe filler”
- Code system
- HCPCS Level II
- Family
- L — Orthotics & prosthetics
- Medicare coverage status
- Special coverage instructions apply
- DMEPOS payment category
- Prosthetics & orthotics
- Prior authorization
- Not on Medicare required-PA list
- Status
- Active (April 2026 HCPCS)
Prior authorization
Not on the Medicare required-PA list as of the January 13, 2026 update (74 items). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.
L5000 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $618.56 to $999.36 depending on state and rural status.
Former-CBA payment limits: ceiling $824.75 · floor $618.56
| State | Non-rural | Rural |
|---|---|---|
| AK | $719.69 | — |
| AL | $647.90 | — |
| AR | $824.75 | — |
| AZ | $735.74 | — |
| CA | $735.74 | — |
| CO | $618.56 | — |
| CT | $618.56 | — |
| DC | $682.33 | — |
| DE | $682.33 | — |
| FL | $647.90 | — |
| GA | $647.90 | — |
| HI | $769.62 | — |
| IA | $646.18 | — |
| ID | $618.56 | — |
| IL | $705.71 | — |
| IN | $705.71 | — |
| KS | $646.18 | — |
| KY | $647.90 | — |
| LA | $824.75 | — |
| MA | $618.56 | — |
| MD | $682.33 | — |
| ME | $618.56 | — |
| MI | $705.71 | — |
| MN | $705.71 | — |
| MO | $646.18 | — |
| MS | $647.90 | — |
| MT | $618.56 | — |
| NC | $647.90 | — |
| ND | $618.56 | — |
| NE | $646.18 | — |
| NH | $618.56 | — |
| NJ | $618.56 | — |
| NM | $824.75 | — |
| NV | $735.74 | — |
| NY | $618.56 | — |
| OH | $705.71 | — |
| OK | $824.75 | — |
| OR | $618.56 | — |
| PA | $682.33 | — |
| PR | $999.36 | — |
| RI | $618.56 | — |
| SC | $647.90 | — |
| SD | $618.56 | — |
| TN | $647.90 | — |
| TX | $824.75 | — |
| UT | $618.56 | — |
| VA | $682.33 | — |
| VI | $618.56 | — |
| VT | $618.56 | — |
| WA | $618.56 | — |
| WI | $705.71 | — |
| WV | $682.33 | — |
| WY | $618.56 | — |
Amounts are the Medicare DMEPOS fee-schedule allowables effective April 2026.
Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%.
A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area
adjustments and non-continental rates can differ — verify with your DME MAC.
Common denial codes to watch
Related L-codes
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