MyMedi-AI

L5670 — Addition to lower extremity, below knee, molded supracondylar suspension ('pts' or similar)

HCPCS Level II L-code · short descriptor: “Bk molded supracondylar susp”

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 2026-10-26; 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 2026-10-26; 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.

L5670 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $193.60 to $496.69 depending on state and rural status.

Former-CBA payment limits: ceiling $442.94 · floor $332.20

StateNon-ruralRural
AK$464.56—
AL$332.20—
AR$442.94—
AZ$442.94—
CA$442.94—
CO$442.94—
CT$352.85—
DC$378.61—
DE$378.61—
FL$332.20—
GA$332.20—
HI$496.69—
IA$332.20—
ID$362.61—
IL$332.20—
IN$332.20—
KS$332.20—
KY$332.20—
LA$442.94—
MA$352.85—
MD$378.61—
ME$352.85—
MI$332.20—
MN$332.20—
MO$332.20—
MS$332.20—
MT$442.94—
NC$332.20—
ND$442.94—
NE$332.20—
NH$352.85—
NJ$343.70—
NM$442.94—
NV$442.94—
NY$343.70—
OH$332.20—
OK$442.94—
OR$362.61—
PA$378.61—
PR$193.60—
RI$352.85—
SC$332.20—
SD$442.94—
TN$332.20—
TX$442.94—
UT$442.94—
VA$378.61—
VI$343.70—
VT$352.85—
WA$362.61—
WI$332.20—
WV$378.61—
WY$442.94—
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 L5670 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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