L5500 — Initial, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed
HCPCS Level II L-code · short descriptor: “Init bk ptb plaster direct”
- 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.
L5500 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $1572.33 to $2284.23 depending on state and rural status.
Former-CBA payment limits: ceiling $2096.44 · floor $1572.33
| State | Non-rural | Rural |
|---|---|---|
| AK | $2100.95 | — |
| AL | $1572.33 | — |
| AR | $1756.84 | — |
| AZ | $2087.82 | — |
| CA | $2087.82 | — |
| CO | $2071.28 | — |
| CT | $1790.73 | — |
| DC | $1572.33 | — |
| DE | $1572.33 | — |
| FL | $1572.33 | — |
| GA | $1572.33 | — |
| HI | $2246.56 | — |
| IA | $2059.70 | — |
| ID | $1572.33 | — |
| IL | $1815.83 | — |
| IN | $1815.83 | — |
| KS | $2059.70 | — |
| KY | $1572.33 | — |
| LA | $1756.84 | — |
| MA | $1790.73 | — |
| MD | $1572.33 | — |
| ME | $1790.73 | — |
| MI | $1815.83 | — |
| MN | $1815.83 | — |
| MO | $2059.70 | — |
| MS | $1572.33 | — |
| MT | $2071.28 | — |
| NC | $1572.33 | — |
| ND | $2071.28 | — |
| NE | $2059.70 | — |
| NH | $1790.73 | — |
| NJ | $1572.33 | — |
| NM | $1756.84 | — |
| NV | $2087.82 | — |
| NY | $1572.33 | — |
| OH | $1815.83 | — |
| OK | $1756.84 | — |
| OR | $1572.33 | — |
| PA | $1572.33 | — |
| PR | $2284.23 | — |
| RI | $1790.73 | — |
| SC | $1572.33 | — |
| SD | $2071.28 | — |
| TN | $1572.33 | — |
| TX | $1756.84 | — |
| UT | $2071.28 | — |
| VA | $1572.33 | — |
| VI | $1572.33 | — |
| VT | $1790.73 | — |
| WA | $1572.33 | — |
| WI | $1815.83 | — |
| WV | $1572.33 | — |
| WY | $2071.28 | — |
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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