L5856 — Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type
HCPCS Level II L-code · short descriptor: “Elec knee-shin swing/stance” · PA required
- 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
- Required (Medicare, since 2020-12-01)
- Status
- Active (April 2026 HCPCS)
Prior authorization
PA REQUIRED L5856 is on Medicare's DMEPOS Required Prior Authorization List (Lower Limb Prosthetics — nationwide since 2020-12-01).
Claims for this item without an affirmed prior-authorization decision are automatically denied (commonly surfacing as CO-197). Submit the PA request to your DME MAC with the order and supporting clinical documentation before delivery.
L5856 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $28851.23 to $31736.36 depending on state and rural status.
Former-CBA payment limits: ceiling $35259.71 · floor $26444.78
| State | Non-rural | Rural |
|---|---|---|
| AK | $28916.42 | — |
| AL | $29719.96 | — |
| AR | $29717.20 | — |
| AZ | $28851.23 | — |
| CA | $28851.23 | — |
| CO | $29862.87 | — |
| CT | $29180.00 | — |
| DC | $28851.23 | — |
| DE | $28851.23 | — |
| FL | $29719.96 | — |
| GA | $29719.96 | — |
| HI | $29372.39 | — |
| IA | $29407.82 | — |
| ID | $28851.23 | — |
| IL | $29559.78 | — |
| IN | $29559.78 | — |
| KS | $29407.82 | — |
| KY | $29719.96 | — |
| LA | $29717.20 | — |
| MA | $29180.00 | — |
| MD | $28851.23 | — |
| ME | $29180.00 | — |
| MI | $29559.78 | — |
| MN | $29559.78 | — |
| MO | $29407.82 | — |
| MS | $29719.96 | — |
| MT | $29862.87 | — |
| NC | $29719.96 | — |
| ND | $29862.87 | — |
| NE | $29407.82 | — |
| NH | $29180.00 | — |
| NJ | $28981.98 | — |
| NM | $29717.20 | — |
| NV | $28851.23 | — |
| NY | $28981.98 | — |
| OH | $29559.78 | — |
| OK | $29717.20 | — |
| OR | $28851.23 | — |
| PA | $28851.23 | — |
| PR | $31736.36 | — |
| RI | $29180.00 | — |
| SC | $29719.96 | — |
| SD | $29862.87 | — |
| TN | $29719.96 | — |
| TX | $29717.20 | — |
| UT | $29862.87 | — |
| VA | $28851.23 | — |
| VI | $28851.23 | — |
| VT | $29180.00 | — |
| WA | $28851.23 | — |
| WI | $29559.78 | — |
| WV | $28851.23 | — |
| WY | $29862.87 | — |
Common denial codes to watch
Related L-codes
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