L5657 — Addition to lower extremity prosthesis, manual/automated adjustable air, fluid, gel or equal socket insert for limb volume management, any materials
HCPCS Level II L-code · short descriptor: “Add low ext man aut vol any”
- 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.
L5657 Medicare fee schedule (October 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable: $306.32 in all listed states.
Former-CBA payment limits: ceiling $367.58 · floor $275.69
| State | Non-rural | Rural |
|---|---|---|
| AK | $306.32 | — |
| AL | $306.32 | — |
| AR | $306.32 | — |
| AZ | $306.32 | — |
| CA | $306.32 | — |
| CO | $306.32 | — |
| CT | $306.32 | — |
| DC | $306.32 | — |
| DE | $306.32 | — |
| FL | $306.32 | — |
| GA | $306.32 | — |
| HI | $306.32 | — |
| IA | $306.32 | — |
| ID | $306.32 | — |
| IL | $306.32 | — |
| IN | $306.32 | — |
| KS | $306.32 | — |
| KY | $306.32 | — |
| LA | $306.32 | — |
| MA | $306.32 | — |
| MD | $306.32 | — |
| ME | $306.32 | — |
| MI | $306.32 | — |
| MN | $306.32 | — |
| MO | $306.32 | — |
| MS | $306.32 | — |
| MT | $306.32 | — |
| NC | $306.32 | — |
| ND | $306.32 | — |
| NE | $306.32 | — |
| NH | $306.32 | — |
| NJ | $306.32 | — |
| NM | $306.32 | — |
| NV | $306.32 | — |
| NY | $306.32 | — |
| OH | $306.32 | — |
| OK | $306.32 | — |
| OR | $306.32 | — |
| PA | $306.32 | — |
| PR | $306.32 | — |
| RI | $306.32 | — |
| SC | $306.32 | — |
| SD | $306.32 | — |
| TN | $306.32 | — |
| TX | $306.32 | — |
| UT | $306.32 | — |
| VA | $306.32 | — |
| VI | $306.32 | — |
| VT | $306.32 | — |
| WA | $306.32 | — |
| WI | $306.32 | — |
| WV | $306.32 | — |
| WY | $306.32 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps L5657 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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