L5857 — Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type
HCPCS Level II L-code · short descriptor: “Elec knee-shin swing only” · 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 L5857 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.
L5857 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $10237.55 to $11261.23 depending on state and rural status.
Former-CBA payment limits: ceiling $12544.36 · floor $9408.27
| State | Non-rural | Rural |
|---|---|---|
| AK | $10302.64 | — |
| AL | $10545.73 | — |
| AR | $10544.80 | — |
| AZ | $10237.55 | — |
| CA | $10237.55 | — |
| CO | $10582.89 | — |
| CT | $10566.30 | — |
| DC | $10237.55 | — |
| DE | $10237.55 | — |
| FL | $10545.73 | — |
| GA | $10545.73 | — |
| HI | $10758.68 | — |
| IA | $10430.64 | — |
| ID | $10237.55 | — |
| IL | $10488.92 | — |
| IN | $10488.92 | — |
| KS | $10430.64 | — |
| KY | $10545.73 | — |
| LA | $10544.80 | — |
| MA | $10566.30 | — |
| MD | $10237.55 | — |
| ME | $10566.30 | — |
| MI | $10488.92 | — |
| MN | $10488.92 | — |
| MO | $10430.64 | — |
| MS | $10545.73 | — |
| MT | $10582.89 | — |
| NC | $10545.73 | — |
| ND | $10582.89 | — |
| NE | $10430.64 | — |
| NH | $10566.30 | — |
| NJ | $10368.27 | — |
| NM | $10544.80 | — |
| NV | $10237.55 | — |
| NY | $10368.27 | — |
| OH | $10488.92 | — |
| OK | $10544.80 | — |
| OR | $10237.55 | — |
| PA | $10237.55 | — |
| PR | $11261.23 | — |
| RI | $10566.30 | — |
| SC | $10545.73 | — |
| SD | $10582.89 | — |
| TN | $10545.73 | — |
| TX | $10544.80 | — |
| UT | $10582.89 | — |
| VA | $10237.55 | — |
| VI | $10237.55 | — |
| VT | $10566.30 | — |
| WA | $10237.55 | — |
| WI | $10488.92 | — |
| WV | $10237.55 | — |
| WY | $10582.89 | — |
Common denial codes to watch
Related L-codes
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