MyMedi-AI

L5680 — Addition to lower extremity, below knee, thigh lacer, nonmolded

HCPCS Level II L-code · short descriptor: “Bk thigh lacer non-molded”

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.

L5680 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $367.32 to $477.19 depending on state and rural status.

Former-CBA payment limits: ceiling $496.84 · floor $372.63

StateNon-ruralRural
AK$367.32—
AL$405.77—
AR$399.64—
AZ$390.41—
CA$390.41—
CO$454.92—
CT$423.01—
DC$424.00—
DE$424.00—
FL$405.77—
GA$405.77—
HI$392.74—
IA$408.95—
ID$434.07—
IL$372.63—
IN$372.63—
KS$408.95—
KY$405.77—
LA$399.64—
MA$423.01—
MD$424.00—
ME$423.01—
MI$372.63—
MN$372.63—
MO$408.95—
MS$405.77—
MT$454.92—
NC$405.77—
ND$454.92—
NE$408.95—
NH$423.01—
NJ$477.19—
NM$399.64—
NV$390.41—
NY$477.19—
OH$372.63—
OK$399.64—
OR$434.07—
PA$424.00—
PR$392.89—
RI$423.01—
SC$405.77—
SD$454.92—
TN$405.77—
TX$399.64—
UT$454.92—
VA$424.00—
VI$477.19—
VT$423.01—
WA$434.07—
WI$372.63—
WV$424.00—
WY$454.92—
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 L5680 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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