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L5637 — Addition to lower extremity, below knee, total contact

HCPCS Level II L-code · short descriptor: “Below knee total contact”

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.

L5637 Medicare fee schedule (April 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $353.67 to $1237.32 depending on state and rural status.

Former-CBA payment limits: ceiling $471.56 · floor $353.67

StateNon-ruralRural
AK$457.84
AL$353.67
AR$471.56
AZ$469.72
CA$469.72
CO$353.67
CT$407.19
DC$416.68
DE$416.68
FL$353.67
GA$353.67
HI$489.59
IA$353.67
ID$364.47
IL$471.56
IN$471.56
KS$353.67
KY$353.67
LA$471.56
MA$407.19
MD$416.68
ME$407.19
MI$471.56
MN$471.56
MO$353.67
MS$353.67
MT$353.67
NC$353.67
ND$353.67
NE$353.67
NH$407.19
NJ$451.24
NM$471.56
NV$469.72
NY$451.24
OH$471.56
OK$471.56
OR$364.47
PA$416.68
PR$1237.32
RI$407.19
SC$353.67
SD$353.67
TN$353.67
TX$471.56
UT$353.67
VA$416.68
VI$451.23
VT$407.19
WA$364.47
WI$471.56
WV$416.68
WY$353.67
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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