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
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.

L5681 Medicare fee schedule (April 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	—

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

CO-50 medical necessity

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