L5858 — Addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type
HCPCS Level II L-code · short descriptor: “Stance phase 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 L5858 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.
L5858 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $22336.47 to $24570.15 depending on state and rural status.
Former-CBA payment limits: ceiling $27258.44 · floor $20443.83
| State | Non-rural | Rural |
|---|---|---|
| AK | $22336.47 | — |
| AL | $23009.05 | — |
| AR | $23006.91 | — |
| AZ | $22336.47 | — |
| CA | $22336.47 | — |
| CO | $23135.94 | — |
| CT | $22336.47 | — |
| DC | $22336.47 | — |
| DE | $22336.47 | — |
| FL | $23009.05 | — |
| GA | $23009.05 | — |
| HI | $22336.47 | — |
| IA | $22772.63 | — |
| ID | $22336.47 | — |
| IL | $22885.05 | — |
| IN | $22885.05 | — |
| KS | $22772.63 | — |
| KY | $23009.05 | — |
| LA | $23006.91 | — |
| MA | $22336.47 | — |
| MD | $22336.47 | — |
| ME | $22336.47 | — |
| MI | $22885.05 | — |
| MN | $22885.05 | — |
| MO | $22772.63 | — |
| MS | $23009.05 | — |
| MT | $23135.94 | — |
| NC | $23009.05 | — |
| ND | $23135.94 | — |
| NE | $22772.63 | — |
| NH | $22336.47 | — |
| NJ | $22336.47 | — |
| NM | $23006.91 | — |
| NV | $22336.47 | — |
| NY | $22336.47 | — |
| OH | $22885.05 | — |
| OK | $23006.91 | — |
| OR | $22336.47 | — |
| PA | $22336.47 | — |
| PR | $24570.15 | — |
| RI | $22336.47 | — |
| SC | $23009.05 | — |
| SD | $23135.94 | — |
| TN | $23009.05 | — |
| TX | $23006.91 | — |
| UT | $23135.94 | — |
| VA | $22336.47 | — |
| VI | $24570.15 | — |
| VT | $22336.47 | — |
| WA | $22336.47 | — |
| WI | $22885.05 | — |
| WV | $22336.47 | — |
| WY | $23135.94 | — |
Common denial codes to watch
Related L-codes
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