MyMedi-AI

L5010 — Partial foot, molded socket, ankle height, with toe filler

HCPCS Level II L-code · short descriptor: “Mold socket ank hgt w/ toe f”

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
Face-to-face & WOPD
Not on the required list
MUE unit limit
2
Status
Active (HCPCS Level II October 2026)

Prior authorization

Not on the Medicare required-PA list (CMS Required Prior Authorization List — 74 items in force on 2026-10-25; 8 more from 2026-10-28; sources: CMS list updated 2026-01-13, CMS-6109-N (91 FR 47972)). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.

Order readiness — what the written order must contain

Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):

  • Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
  • General description of the item (42 CFR 410.38(d)(1)(i)(B))
  • Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
  • Order date (42 CFR 410.38(d)(1)(i)(D))
  • Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
  • Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))

Not on the F2F/WOPD list (CMS Required F2F & WOPD List — 83 items in force on 2026-10-25; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). The standard written order must reach the supplier before claim submission.

Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.

L5010 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $999.36 to $1971.82 depending on state and rural status.

Former-CBA payment limits: ceiling $1987.27 · floor $1490.45

StateNon-ruralRural
AK$1620.13—
AL$1564.83—
AR$1872.71—
AZ$1651.72—
CA$1651.72—
CO$1635.10—
CT$1499.32—
DC$1490.45—
DE$1490.45—
FL$1564.83—
GA$1564.83—
HI$1732.39—
IA$1725.84—
ID$1490.45—
IL$1971.82—
IN$1971.82—
KS$1725.84—
KY$1564.83—
LA$1872.71—
MA$1499.32—
MD$1490.45—
ME$1499.32—
MI$1971.82—
MN$1971.82—
MO$1725.84—
MS$1564.83—
MT$1635.10—
NC$1564.83—
ND$1635.10—
NE$1725.84—
NH$1499.32—
NJ$1892.02—
NM$1872.71—
NV$1651.72—
NY$1892.02—
OH$1971.82—
OK$1872.71—
OR$1490.45—
PA$1490.45—
PR$999.36—
RI$1499.32—
SC$1564.83—
SD$1635.10—
TN$1564.83—
TX$1872.71—
UT$1635.10—
VA$1490.45—
VI$1892.02—
VT$1499.32—
WA$1490.45—
WI$1971.82—
WV$1490.45—
WY$1635.10—
Amounts are the Medicare DMEPOS fee-schedule allowables effective October 2026 (CMS DMEPOS Fee Schedule October 2026 (DME26-D)). 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.

Unit limit (MUE)

Medicare's Medically Unlikely Edit caps L5010 at 2 units per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: Anatomic Consideration.

Common denial codes to watch

Related L-codes

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