MyMedi-AI

L5661 — Addition to lower extremity, socket insert, multi-durometer symes

HCPCS Level II L-code · short descriptor: “Multi-durometer symes”

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.

L5661 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $704.30 to $1012.99 depending on state and rural status.

Former-CBA payment limits: ceiling $993.35 · floor $745.01

StateNon-ruralRural
AK$947.33—
AL$745.01—
AR$745.01—
AZ$920.87—
CA$920.87—
CO$745.01—
CT$993.35—
DC$819.53—
DE$819.53—
FL$745.01—
GA$745.01—
HI$1012.99—
IA$835.72—
ID$745.01—
IL$801.96—
IN$801.96—
KS$835.72—
KY$745.01—
LA$745.01—
MA$993.35—
MD$819.53—
ME$993.35—
MI$801.96—
MN$801.96—
MO$835.72—
MS$745.01—
MT$745.01—
NC$745.01—
ND$745.01—
NE$835.72—
NH$993.35—
NJ$747.20—
NM$745.01—
NV$920.87—
NY$747.20—
OH$801.96—
OK$745.01—
OR$745.01—
PA$819.53—
PR$704.30—
RI$993.35—
SC$745.01—
SD$745.01—
TN$745.01—
TX$745.01—
UT$745.01—
VA$819.53—
VI$747.20—
VT$993.35—
WA$745.01—
WI$801.96—
WV$819.53—
WY$745.01—
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 L5661 at 2 units per date of service (clinical). Units above the MUE deny — typically as CO-151. Rationale: Anatomic Consideration.

Common denial codes to watch

Related L-codes

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