MyMedi-AI

L5682 — Addition to lower extremity, below knee, thigh lacer, gluteal/ischial, molded

HCPCS Level II L-code · short descriptor: “Bk thigh lacer glut/ischia m”

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.

L5682 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $713.83 to $1247.08 depending on state and rural status.

Former-CBA payment limits: ceiling $1020.84 · floor $765.63

StateNon-ruralRural
AK$1166.21—
AL$765.63—
AR$781.15—
AZ$1020.84—
CA$1020.84—
CO$765.63—
CT$1020.84—
DC$765.63—
DE$765.63—
FL$765.63—
GA$765.63—
HI$1247.08—
IA$823.48—
ID$774.05—
IL$765.63—
IN$765.63—
KS$823.48—
KY$765.63—
LA$781.15—
MA$1020.84—
MD$765.63—
ME$1020.84—
MI$765.63—
MN$765.63—
MO$823.48—
MS$765.63—
MT$765.63—
NC$765.63—
ND$765.63—
NE$823.48—
NH$1020.84—
NJ$798.12—
NM$781.15—
NV$1020.84—
NY$798.12—
OH$765.63—
OK$781.15—
OR$774.05—
PA$765.63—
PR$713.83—
RI$1020.84—
SC$765.63—
SD$765.63—
TN$765.63—
TX$781.15—
UT$765.63—
VA$765.63—
VI$798.12—
VT$1020.84—
WA$774.05—
WI$765.63—
WV$765.63—
WY$765.63—
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 L5682 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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