L5703 — Ankle, symes, molded to patient model, socket without solid ankle cushion heel (sach) foot, replacement only
HCPCS Level II L-code · short descriptor: “Symes ankle w/o (sach) foot”
- 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.
L5703 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $2560.96 to $3474.01 depending on state and rural status.
Former-CBA payment limits: ceiling $3414.62 · floor $2560.96
| State | Non-rural | Rural |
|---|---|---|
| AK | $2918.60 | — |
| AL | $2758.03 | — |
| AR | $3262.87 | — |
| AZ | $2946.99 | — |
| CA | $2946.99 | — |
| CO | $2769.92 | — |
| CT | $2894.38 | — |
| DC | $2560.96 | — |
| DE | $2560.96 | — |
| FL | $2758.03 | — |
| GA | $2758.03 | — |
| HI | $3120.92 | — |
| IA | $2575.53 | — |
| ID | $2999.78 | — |
| IL | $3106.52 | — |
| IN | $3106.52 | — |
| KS | $2575.53 | — |
| KY | $2758.03 | — |
| LA | $3262.87 | — |
| MA | $2894.38 | — |
| MD | $2560.96 | — |
| ME | $2894.38 | — |
| MI | $3106.52 | — |
| MN | $3106.52 | — |
| MO | $2575.53 | — |
| MS | $2758.03 | — |
| MT | $2769.92 | — |
| NC | $2758.03 | — |
| ND | $2769.92 | — |
| NE | $2575.53 | — |
| NH | $2894.38 | — |
| NJ | $2847.69 | — |
| NM | $3262.87 | — |
| NV | $2946.99 | — |
| NY | $2847.69 | — |
| OH | $3106.52 | — |
| OK | $3262.87 | — |
| OR | $2999.78 | — |
| PA | $2560.96 | — |
| PR | $3474.01 | — |
| RI | $2894.38 | — |
| SC | $2758.03 | — |
| SD | $2769.92 | — |
| TN | $2758.03 | — |
| TX | $3262.87 | — |
| UT | $2769.92 | — |
| VA | $2560.96 | — |
| VI | $3414.62 | — |
| VT | $2894.38 | — |
| WA | $2999.78 | — |
| WI | $3106.52 | — |
| WV | $2560.96 | — |
| WY | $2769.92 | — |
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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