L5520 — Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed
HCPCS Level II L-code · short descriptor: “Perp bk ptb thermopls 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.
L5520 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $1760.53 to $3045.67 depending on state and rural status.
Former-CBA payment limits: ceiling $2347.37 · floor $1760.53
| State | Non-rural | Rural |
|---|---|---|
| AK | $2276.83 | — |
| AL | $1760.53 | — |
| AR | $2347.37 | — |
| AZ | $2345.94 | — |
| CA | $2345.94 | — |
| CO | $1760.53 | — |
| CT | $2338.22 | — |
| DC | $1760.53 | — |
| DE | $1760.53 | — |
| FL | $1760.53 | — |
| GA | $1760.53 | — |
| HI | $2434.61 | — |
| IA | $2148.79 | — |
| ID | $1760.53 | — |
| IL | $1943.72 | — |
| IN | $1943.72 | — |
| KS | $2148.79 | — |
| KY | $1760.53 | — |
| LA | $2347.37 | — |
| MA | $2338.22 | — |
| MD | $1760.53 | — |
| ME | $2338.22 | — |
| MI | $1943.72 | — |
| MN | $1943.72 | — |
| MO | $2148.79 | — |
| MS | $1760.53 | — |
| MT | $1760.53 | — |
| NC | $1760.53 | — |
| ND | $1760.53 | — |
| NE | $2148.79 | — |
| NH | $2338.22 | — |
| NJ | $2150.91 | — |
| NM | $2347.37 | — |
| NV | $2345.94 | — |
| NY | $2150.91 | — |
| OH | $1943.72 | — |
| OK | $2347.37 | — |
| OR | $1760.53 | — |
| PA | $1760.53 | — |
| PR | $3045.67 | — |
| RI | $2338.22 | — |
| SC | $1760.53 | — |
| SD | $1760.53 | — |
| TN | $1760.53 | — |
| TX | $2347.37 | — |
| UT | $1760.53 | — |
| VA | $1760.53 | — |
| VI | $2150.91 | — |
| VT | $2338.22 | — |
| WA | $1760.53 | — |
| WI | $1943.72 | — |
| WV | $1760.53 | — |
| WY | $1760.53 | — |
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 L5520 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 →