L5250 — Hip disarticulation, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot
HCPCS Level II L-code · short descriptor: “Hip canad sing axi cons fric”
- Code system
- HCPCS Level II
- Family
- L — Orthotics & prosthetics
- Medicare coverage status
- Carrier judgment — coverage decided by the DME MAC
- 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.
L5250 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $6352.07 to $12373.02 depending on state and rural status.
Former-CBA payment limits: ceiling $8469.42 · floor $6352.07
| State | Non-rural | Rural |
|---|---|---|
| AK | $10597.59 | — |
| AL | $6352.07 | — |
| AR | $6907.11 | — |
| AZ | $8469.42 | — |
| CA | $8469.42 | — |
| CO | $7978.90 | — |
| CT | $6821.01 | — |
| DC | $6352.07 | — |
| DE | $6352.07 | — |
| FL | $6352.07 | — |
| GA | $6352.07 | — |
| HI | $11332.06 | — |
| IA | $7139.05 | — |
| ID | $7835.96 | — |
| IL | $6884.81 | — |
| IN | $6884.81 | — |
| KS | $7139.05 | — |
| KY | $6352.07 | — |
| LA | $6907.11 | — |
| MA | $6821.01 | — |
| MD | $6352.07 | — |
| ME | $6821.01 | — |
| MI | $6884.81 | — |
| MN | $6884.81 | — |
| MO | $7139.05 | — |
| MS | $6352.07 | — |
| MT | $7978.90 | — |
| NC | $6352.07 | — |
| ND | $7978.90 | — |
| NE | $7139.05 | — |
| NH | $6821.01 | — |
| NJ | $6784.85 | — |
| NM | $6907.11 | — |
| NV | $8469.42 | — |
| NY | $6784.85 | — |
| OH | $6884.81 | — |
| OK | $6907.11 | — |
| OR | $7835.96 | — |
| PA | $6352.07 | — |
| PR | $12373.02 | — |
| RI | $6821.01 | — |
| SC | $6352.07 | — |
| SD | $7978.90 | — |
| TN | $6352.07 | — |
| TX | $6907.11 | — |
| UT | $7978.90 | — |
| VA | $6352.07 | — |
| VI | $6784.84 | — |
| VT | $6821.01 | — |
| WA | $7835.96 | — |
| WI | $6884.81 | — |
| WV | $6352.07 | — |
| WY | $7978.90 | — |
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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