L5699 — All lower extremity prostheses, shoulder harness
HCPCS Level II L-code · short descriptor: “Shoulder harness”
- 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
- 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.
L5699 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $102.32 to $424.90 depending on state and rural status.
Former-CBA payment limits: ceiling $304.35 · floor $228.26
| State | Non-rural | Rural |
|---|---|---|
| AK | $397.36 | — |
| AL | $289.51 | — |
| AR | $228.26 | — |
| AZ | $304.35 | — |
| CA | $304.35 | — |
| CO | $228.26 | — |
| CT | $295.29 | — |
| DC | $228.26 | — |
| DE | $228.26 | — |
| FL | $289.51 | — |
| GA | $289.51 | — |
| HI | $424.90 | — |
| IA | $228.26 | — |
| ID | $300.95 | — |
| IL | $251.10 | — |
| IN | $251.10 | — |
| KS | $228.26 | — |
| KY | $289.51 | — |
| LA | $228.26 | — |
| MA | $295.29 | — |
| MD | $228.26 | — |
| ME | $295.29 | — |
| MI | $251.10 | — |
| MN | $251.10 | — |
| MO | $228.26 | — |
| MS | $289.51 | — |
| MT | $228.26 | — |
| NC | $289.51 | — |
| ND | $228.26 | — |
| NE | $228.26 | — |
| NH | $295.29 | — |
| NJ | $232.85 | — |
| NM | $228.26 | — |
| NV | $304.35 | — |
| NY | $232.85 | — |
| OH | $251.10 | — |
| OK | $228.26 | — |
| OR | $300.95 | — |
| PA | $228.26 | — |
| PR | $102.32 | — |
| RI | $295.29 | — |
| SC | $289.51 | — |
| SD | $228.26 | — |
| TN | $289.51 | — |
| TX | $228.26 | — |
| UT | $228.26 | — |
| VA | $228.26 | — |
| VI | $232.85 | — |
| VT | $295.29 | — |
| WA | $300.95 | — |
| WI | $251.10 | — |
| WV | $228.26 | — |
| WY | $228.26 | — |
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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