L5785 — Addition, exoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)
HCPCS Level II L-code · short descriptor: “Exoskeletal bk ultralt mater”
- 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.
L5785 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $636.06 to $848.09 depending on state and rural status.
Former-CBA payment limits: ceiling $848.09 · floor $636.06
| State | Non-rural | Rural |
|---|---|---|
| AK | $678.67 | — |
| AL | $787.90 | — |
| AR | $709.19 | — |
| AZ | $672.47 | — |
| CA | $672.47 | — |
| CO | $636.06 | — |
| CT | $848.09 | — |
| DC | $636.06 | — |
| DE | $636.06 | — |
| FL | $787.90 | — |
| GA | $787.90 | — |
| HI | $725.69 | — |
| IA | $636.07 | — |
| ID | $759.84 | — |
| IL | $636.06 | — |
| IN | $636.06 | — |
| KS | $636.07 | — |
| KY | $787.90 | — |
| LA | $709.19 | — |
| MA | $848.09 | — |
| MD | $636.06 | — |
| ME | $848.09 | — |
| MI | $636.06 | — |
| MN | $636.06 | — |
| MO | $636.07 | — |
| MS | $787.90 | — |
| MT | $636.06 | — |
| NC | $787.90 | — |
| ND | $636.06 | — |
| NE | $636.07 | — |
| NH | $848.09 | — |
| NJ | $636.06 | — |
| NM | $709.19 | — |
| NV | $672.47 | — |
| NY | $636.06 | — |
| OH | $636.06 | — |
| OK | $709.19 | — |
| OR | $759.84 | — |
| PA | $636.06 | — |
| PR | $713.83 | — |
| RI | $848.09 | — |
| SC | $787.90 | — |
| SD | $636.06 | — |
| TN | $787.90 | — |
| TX | $709.19 | — |
| UT | $636.06 | — |
| VA | $636.06 | — |
| VI | $636.06 | — |
| VT | $848.09 | — |
| WA | $759.84 | — |
| WI | $636.06 | — |
| WV | $636.06 | — |
| WY | $636.06 | — |
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
Bill L5785 with confidence
MyMedi-AI scrubs whole claims against NCCI pairs, MUE limits, modifier rules, and PA flags before you submit — built for DME teams, no PHI stored on our servers.
Start free trial Run a CMS-0057-F readiness checkPrefer DIY compliance? Self-audit documentation kits for DME suppliers →