L5681 — Addition to lower extremity, below knee/above knee, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l5673 or l5679)
HCPCS Level II L-code · short descriptor: “Intl custm cong/latyp insert”
- 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.
L5681 Medicare fee schedule (October 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $1580.90 to $1738.98 depending on state and rural status.
Former-CBA payment limits: ceiling $1929.74 · floor $1447.31
| State | Non-rural | Rural |
|---|---|---|
| AK | $1580.90 | — |
| AL | $1628.51 | — |
| AR | $1628.34 | — |
| AZ | $1580.90 | — |
| CA | $1580.90 | — |
| CO | $1640.77 | — |
| CT | $1580.90 | — |
| DC | $1580.90 | — |
| DE | $1580.90 | — |
| FL | $1628.51 | — |
| GA | $1628.51 | — |
| HI | $1580.90 | — |
| IA | $1611.74 | — |
| ID | $1580.90 | — |
| IL | $1619.74 | — |
| IN | $1619.74 | — |
| KS | $1611.74 | — |
| KY | $1628.51 | — |
| LA | $1628.34 | — |
| MA | $1580.90 | — |
| MD | $1580.90 | — |
| ME | $1580.90 | — |
| MI | $1619.74 | — |
| MN | $1619.74 | — |
| MO | $1611.74 | — |
| MS | $1628.51 | — |
| MT | $1640.77 | — |
| NC | $1628.51 | — |
| ND | $1640.77 | — |
| NE | $1611.74 | — |
| NH | $1580.90 | — |
| NJ | $1580.90 | — |
| NM | $1628.34 | — |
| NV | $1580.90 | — |
| NY | $1580.90 | — |
| OH | $1619.74 | — |
| OK | $1628.34 | — |
| OR | $1580.90 | — |
| PA | $1580.90 | — |
| PR | $1738.98 | — |
| RI | $1580.90 | — |
| SC | $1628.51 | — |
| SD | $1640.77 | — |
| TN | $1628.51 | — |
| TX | $1628.34 | — |
| UT | $1640.77 | — |
| VA | $1580.90 | — |
| VI | $1738.98 | — |
| VT | $1580.90 | — |
| WA | $1580.90 | — |
| WI | $1619.74 | — |
| WV | $1580.90 | — |
| WY | $1640.77 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps L5681 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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