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L5400 — Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment, suspension, and one cast change, below knee

HCPCS Level II L-code · short descriptor: “Postop dress & 1 cast chg bk”

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
Face-to-face & WOPD
Not on the required 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.

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 (April 13, 2026 update — 83 items). The standard written order must reach the supplier before claim submission.

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

L5400 Medicare fee schedule (April 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $869.13 to $2148.18 depending on state and rural status.

Former-CBA payment limits: ceiling $1964.57 · floor $1473.43

StateNon-ruralRural
AK$2008.91
AL$1667.22
AR$1745.96
AZ$1942.65
CA$1942.65
CO$1502.44
CT$1473.43
DC$1473.43
DE$1473.43
FL$1667.22
GA$1667.22
HI$2148.18
IA$1657.17
ID$1637.18
IL$1964.57
IN$1964.57
KS$1657.17
KY$1667.22
LA$1745.96
MA$1473.43
MD$1473.43
ME$1473.43
MI$1964.57
MN$1964.57
MO$1657.17
MS$1667.22
MT$1502.44
NC$1667.22
ND$1502.44
NE$1657.17
NH$1473.43
NJ$1473.43
NM$1745.96
NV$1942.65
NY$1473.43
OH$1964.57
OK$1745.96
OR$1637.18
PA$1473.43
PR$869.13
RI$1473.43
SC$1667.22
SD$1502.44
TN$1667.22
TX$1745.96
UT$1502.44
VA$1473.43
VI$1473.43
VT$1473.43
WA$1637.18
WI$1964.57
WV$1473.43
WY$1502.44
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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