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L5560 — Preparatory, above knee- knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model

HCPCS Level II L-code · short descriptor: “Prep ak ischial plast molded”

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.

L5560 Medicare fee schedule (April 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $2379.43 to $4568.53 depending on state and rural status.

Former-CBA payment limits: ceiling $3172.57 · floor $2379.43

StateNon-ruralRural
AK$2884.10
AL$2379.43
AR$3134.29
AZ$2878.04
CA$2878.04
CO$2907.33
CT$2407.10
DC$2379.43
DE$2379.43
FL$2379.43
GA$2379.43
HI$3083.98
IA$2658.53
ID$2646.28
IL$2874.62
IN$2874.62
KS$2658.53
KY$2379.43
LA$3134.29
MA$2407.10
MD$2379.43
ME$2407.10
MI$2874.62
MN$2874.62
MO$2658.53
MS$2379.43
MT$2907.33
NC$2379.43
ND$2907.33
NE$2658.53
NH$2407.10
NJ$2780.34
NM$3134.29
NV$2878.04
NY$2780.34
OH$2874.62
OK$3134.29
OR$2646.28
PA$2379.43
PR$4568.53
RI$2407.10
SC$2379.43
SD$2907.33
TN$2379.43
TX$3134.29
UT$2907.33
VA$2379.43
VI$2780.35
VT$2407.10
WA$2646.28
WI$2874.62
WV$2379.43
WY$2907.33
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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