L5859 — Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s)
HCPCS Level II L-code · short descriptor: “Knee-shin pro flex/ext cont”
- 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.
L5859 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $17437.90 to $19181.69 depending on state and rural status.
Former-CBA payment limits: ceiling $21356.93 · floor $16017.70
| State | Non-rural | Rural |
|---|---|---|
| AK | $17437.90 | — |
| AL | $17962.99 | — |
| AR | $17961.29 | — |
| AZ | $17437.90 | — |
| CA | $17437.90 | — |
| CO | $18062.02 | — |
| CT | $17437.90 | — |
| DC | $17437.90 | — |
| DE | $17437.90 | — |
| FL | $17962.99 | — |
| GA | $17962.99 | — |
| HI | $17437.90 | — |
| IA | $17778.41 | — |
| ID | $18479.11 | — |
| IL | $17866.14 | — |
| IN | $17866.14 | — |
| KS | $17778.41 | — |
| KY | $17962.99 | — |
| LA | $17961.29 | — |
| MA | $17437.90 | — |
| MD | $17437.90 | — |
| ME | $17437.90 | — |
| MI | $17866.14 | — |
| MN | $17866.14 | — |
| MO | $17778.41 | — |
| MS | $17962.99 | — |
| MT | $18062.02 | — |
| NC | $17962.99 | — |
| ND | $18062.02 | — |
| NE | $17778.41 | — |
| NH | $17437.90 | — |
| NJ | $17437.90 | — |
| NM | $17961.29 | — |
| NV | $17437.90 | — |
| NY | $17437.90 | — |
| OH | $17866.14 | — |
| OK | $17961.29 | — |
| OR | $18479.11 | — |
| PA | $17437.90 | — |
| PR | $19181.69 | — |
| RI | $17437.90 | — |
| SC | $17962.99 | — |
| SD | $18062.02 | — |
| TN | $17962.99 | — |
| TX | $17961.29 | — |
| UT | $18062.02 | — |
| VA | $17437.90 | — |
| VI | $19181.69 | — |
| VT | $17437.90 | — |
| WA | $18479.11 | — |
| WI | $17866.14 | — |
| WV | $17437.90 | — |
| WY | $18062.02 | — |
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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