L5570 — Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed
HCPCS Level II L-code · short descriptor: “Prep ak ischial direct form”
- 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.
L5570 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $1308.69 to $3428.66 depending on state and rural status.
Former-CBA payment limits: ceiling $3298.35 · floor $2473.76
| State | Non-rural | Rural |
|---|---|---|
| AK | $3206.43 | — |
| AL | $2473.76 | — |
| AR | $3094.56 | — |
| AZ | $3155.30 | — |
| CA | $3155.30 | — |
| CO | $3146.23 | — |
| CT | $2903.01 | — |
| DC | $2473.76 | — |
| DE | $2473.76 | — |
| FL | $2473.76 | — |
| GA | $2473.76 | — |
| HI | $3428.66 | — |
| IA | $2940.58 | — |
| ID | $2783.38 | — |
| IL | $2789.92 | — |
| IN | $2789.92 | — |
| KS | $2940.58 | — |
| KY | $2473.76 | — |
| LA | $3094.56 | — |
| MA | $2903.01 | — |
| MD | $2473.76 | — |
| ME | $2903.01 | — |
| MI | $2789.92 | — |
| MN | $2789.92 | — |
| MO | $2940.58 | — |
| MS | $2473.76 | — |
| MT | $3146.23 | — |
| NC | $2473.76 | — |
| ND | $3146.23 | — |
| NE | $2940.58 | — |
| NH | $2903.01 | — |
| NJ | $2800.49 | — |
| NM | $3094.56 | — |
| NV | $3155.30 | — |
| NY | $2800.49 | — |
| OH | $2789.92 | — |
| OK | $3094.56 | — |
| OR | $2783.38 | — |
| PA | $2473.76 | — |
| PR | $1308.69 | — |
| RI | $2903.01 | — |
| SC | $2473.76 | — |
| SD | $3146.23 | — |
| TN | $2473.76 | — |
| TX | $3094.56 | — |
| UT | $3146.23 | — |
| VA | $2473.76 | — |
| VI | $2800.49 | — |
| VT | $2903.01 | — |
| WA | $2783.38 | — |
| WI | $2789.92 | — |
| WV | $2473.76 | — |
| WY | $3146.23 | — |
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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