MyMedi-AI

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
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.

L5699 Medicare fee schedule (October 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

StateNon-ruralRural
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 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 L5699 at 2 units per date of service (clinical). Units above the MUE deny — typically as CO-151. Rationale: Anatomic Consideration.

Common denial codes to watch

Related L-codes

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