L5331 — Hip disarticulation, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot
HCPCS Level II L-code · short descriptor: “Hip disart canadian sach ft”
- 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.
L5331 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $4859.45 to $7517.95 depending on state and rural status.
Former-CBA payment limits: ceiling $7591.65 · floor $5693.73
| State | Non-rural | Rural |
|---|---|---|
| AK | $6759.89 | — |
| AL | $6219.83 | — |
| AR | $7091.52 | — |
| AZ | $7129.62 | — |
| CA | $7129.62 | — |
| CO | $6858.59 | — |
| CT | $6313.06 | — |
| DC | $5693.73 | — |
| DE | $5693.73 | — |
| FL | $6219.83 | — |
| GA | $6219.83 | — |
| HI | $7344.12 | — |
| IA | $6801.84 | — |
| ID | $7517.95 | — |
| IL | $6443.12 | — |
| IN | $6443.12 | — |
| KS | $6801.84 | — |
| KY | $6219.83 | — |
| LA | $7091.52 | — |
| MA | $6313.06 | — |
| MD | $5693.73 | — |
| ME | $6313.06 | — |
| MI | $6443.12 | — |
| MN | $6443.12 | — |
| MO | $6801.84 | — |
| MS | $6219.83 | — |
| MT | $6858.59 | — |
| NC | $6219.83 | — |
| ND | $6858.59 | — |
| NE | $6801.84 | — |
| NH | $6313.06 | — |
| NJ | $5693.73 | — |
| NM | $7091.52 | — |
| NV | $7129.62 | — |
| NY | $5693.73 | — |
| OH | $6443.12 | — |
| OK | $7091.52 | — |
| OR | $7517.95 | — |
| PA | $5693.73 | — |
| PR | $4859.45 | — |
| RI | $6313.06 | — |
| SC | $6219.83 | — |
| SD | $6858.59 | — |
| TN | $6219.83 | — |
| TX | $7091.52 | — |
| UT | $6858.59 | — |
| VA | $5693.73 | — |
| VI | $5693.73 | — |
| VT | $6313.06 | — |
| WA | $7517.95 | — |
| WI | $6443.12 | — |
| WV | $5693.73 | — |
| WY | $6858.59 | — |
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
Bill L5331 with confidence
MyMedi-AI scrubs whole claims against NCCI pairs, MUE limits, modifier rules, and PA flags before you submit — built for DME teams, no PHI stored on our servers.
Start free trial Run a CMS-0057-F readiness checkPrefer DIY compliance? Self-audit documentation kits for DME suppliers →