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L5678 — Additions to lower extremity, below knee, joint covers, pair

HCPCS Level II L-code · short descriptor: “Bk joint covers pair”

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
Status
Active (April 2026 HCPCS)

Prior authorization

Not on the Medicare required-PA list as of the January 13, 2026 update (74 items). 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 (April 13, 2026 update — 83 items). The standard written order must reach the supplier before claim submission.

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

L5678 Medicare fee schedule (April 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $19.03 to $107.44 depending on state and rural status.

Former-CBA payment limits: ceiling $64.81 · floor $48.61

StateNon-ruralRural
AK$100.43
AL$48.61
AR$64.81
AZ$64.81
CA$64.81
CO$63.25
CT$48.61
DC$48.61
DE$48.61
FL$48.61
GA$48.61
HI$107.44
IA$54.72
ID$57.93
IL$48.61
IN$48.61
KS$54.72
KY$48.61
LA$64.81
MA$48.61
MD$48.61
ME$48.61
MI$48.61
MN$48.61
MO$54.72
MS$48.61
MT$63.25
NC$48.61
ND$63.25
NE$54.72
NH$48.61
NJ$48.61
NM$64.81
NV$64.81
NY$48.61
OH$48.61
OK$64.81
OR$57.93
PA$48.61
PR$19.03
RI$48.61
SC$48.61
SD$63.25
TN$48.61
TX$64.81
UT$63.25
VA$48.61
VI$48.61
VT$48.61
WA$57.93
WI$48.61
WV$48.61
WY$63.25
Amounts are the Medicare DMEPOS fee-schedule allowables effective April 2026. 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.

Common denial codes to watch

Related L-codes

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