MyMedi-AI

L5644 — Addition to lower extremity, above knee, wood socket

HCPCS Level II L-code · short descriptor: “Above knee wood 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.

L5644 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $409.12 to $964.12 depending on state and rural status.

Former-CBA payment limits: ceiling $964.12 · floor $723.09

StateNon-ruralRural
AK$662.25—
AL$723.09—
AR$862.59—
AZ$723.09—
CA$723.09—
CO$964.12—
CT$948.82—
DC$723.09—
DE$723.09—
FL$723.09—
GA$723.09—
HI$708.10—
IA$790.43—
ID$807.34—
IL$723.09—
IN$723.09—
KS$790.43—
KY$723.09—
LA$862.59—
MA$948.82—
MD$723.09—
ME$948.82—
MI$723.09—
MN$723.09—
MO$790.43—
MS$723.09—
MT$964.12—
NC$723.09—
ND$964.12—
NE$790.43—
NH$948.82—
NJ$723.09—
NM$862.59—
NV$723.09—
NY$723.09—
OH$723.09—
OK$862.59—
OR$807.34—
PA$723.09—
PR$409.12—
RI$948.82—
SC$723.09—
SD$964.12—
TN$723.09—
TX$862.59—
UT$964.12—
VA$723.09—
VI$723.09—
VT$948.82—
WA$807.34—
WI$723.09—
WV$723.09—
WY$964.12—
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 L5644 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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