MyMedi-AI

L5638 — Addition to lower extremity, below knee, leather socket

HCPCS Level II L-code · short descriptor: “Below knee leather socket”

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
MUE unit limit
2
Status
Active (HCPCS Level II October 2026)

Prior authorization

Not on the Medicare required-PA list (CMS Required Prior Authorization List — 74 items in force on 2026-10-25; 8 more from 2026-10-28; sources: CMS list updated 2026-01-13, CMS-6109-N (91 FR 47972)). 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 (CMS Required F2F & WOPD List — 83 items in force on 2026-10-25; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). The standard written order must reach the supplier before claim submission.

Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.

L5638 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $153.44 to $938.57 depending on state and rural status.

Former-CBA payment limits: ceiling $794.39 · floor $595.79

StateNon-ruralRural
AK$877.78—
AL$616.08—
AR$617.95—
AZ$794.39—
CA$794.39—
CO$794.39—
CT$595.79—
DC$595.79—
DE$595.79—
FL$616.08—
GA$616.08—
HI$938.57—
IA$595.79—
ID$675.38—
IL$794.39—
IN$794.39—
KS$595.79—
KY$616.08—
LA$617.95—
MA$595.79—
MD$595.79—
ME$595.79—
MI$794.39—
MN$794.39—
MO$595.79—
MS$616.08—
MT$794.39—
NC$616.08—
ND$794.39—
NE$595.79—
NH$595.79—
NJ$716.81—
NM$617.95—
NV$794.39—
NY$716.81—
OH$794.39—
OK$617.95—
OR$675.38—
PA$595.79—
PR$153.44—
RI$595.79—
SC$616.08—
SD$794.39—
TN$616.08—
TX$617.95—
UT$794.39—
VA$595.79—
VI$716.81—
VT$595.79—
WA$675.38—
WI$794.39—
WV$595.79—
WY$794.39—
Amounts are the Medicare DMEPOS fee-schedule allowables effective October 2026 (CMS DMEPOS Fee Schedule October 2026 (DME26-D)). 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.

Unit limit (MUE)

Medicare's Medically Unlikely Edit caps L5638 at 2 units per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: Anatomic Consideration.

Common denial codes to watch

Related L-codes

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