L5585 — Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, prefabricated adjustable open end socket
HCPCS Level II L-code · short descriptor: “Prep ak ischial open end”
- 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.
L5585 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $3132.31 to $4568.53 depending on state and rural status.
Former-CBA payment limits: ceiling $4176.42 · floor $3132.31
| State | Non-rural | Rural |
|---|---|---|
| AK | $3449.56 | — |
| AL | $3554.08 | — |
| AR | $3466.68 | — |
| AZ | $3391.68 | — |
| CA | $3391.68 | — |
| CO | $3543.26 | — |
| CT | $3370.12 | — |
| DC | $3132.31 | — |
| DE | $3132.31 | — |
| FL | $3554.08 | — |
| GA | $3554.08 | — |
| HI | $3688.63 | — |
| IA | $3403.98 | — |
| ID | $3533.97 | — |
| IL | $4055.09 | — |
| IN | $4055.09 | — |
| KS | $3403.98 | — |
| KY | $3554.08 | — |
| LA | $3466.68 | — |
| MA | $3370.12 | — |
| MD | $3132.31 | — |
| ME | $3370.12 | — |
| MI | $4055.09 | — |
| MN | $4055.09 | — |
| MO | $3403.98 | — |
| MS | $3554.08 | — |
| MT | $3543.26 | — |
| NC | $3554.08 | — |
| ND | $3543.26 | — |
| NE | $3403.98 | — |
| NH | $3370.12 | — |
| NJ | $3132.31 | — |
| NM | $3466.68 | — |
| NV | $3391.68 | — |
| NY | $3132.31 | — |
| OH | $4055.09 | — |
| OK | $3466.68 | — |
| OR | $3533.97 | — |
| PA | $3132.31 | — |
| PR | $4568.53 | — |
| RI | $3370.12 | — |
| SC | $3554.08 | — |
| SD | $3543.26 | — |
| TN | $3554.08 | — |
| TX | $3466.68 | — |
| UT | $3543.26 | — |
| VA | $3132.31 | — |
| VI | $3132.31 | — |
| VT | $3370.12 | — |
| WA | $3533.97 | — |
| WI | $4055.09 | — |
| WV | $3132.31 | — |
| WY | $3543.26 | — |
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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