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L5970 — All lower extremity prostheses, foot, external keel, sach foot

HCPCS Level II L-code · short descriptor: “Foot external keel sach foot”

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
Face-to-face & WOPD
Not on the required 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.

Order readiness — what the written order must contain

Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):

  • Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
  • General description of the item (42 CFR 410.38(d)(1)(i)(B))
  • Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
  • Order date (42 CFR 410.38(d)(1)(i)(D))
  • Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
  • Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))

Not on the F2F/WOPD list (April 13, 2026 update — 83 items). The standard written order must reach the supplier before claim submission.

Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.

L5970 Medicare fee schedule (April 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $248.63 to $348.56 depending on state and rural status.

Former-CBA payment limits: ceiling $331.51 · floor $248.63

StateNon-ruralRural
AK$326.00
AL$248.63
AR$278.64
AZ$312.80
CA$312.80
CO$277.97
CT$331.51
DC$268.76
DE$268.76
FL$248.63
GA$248.63
HI$348.56
IA$256.70
ID$300.30
IL$267.47
IN$267.47
KS$256.70
KY$248.63
LA$278.64
MA$331.51
MD$268.76
ME$331.51
MI$267.47
MN$267.47
MO$256.70
MS$248.63
MT$277.97
NC$248.63
ND$277.97
NE$256.70
NH$331.51
NJ$248.63
NM$278.64
NV$312.80
NY$248.63
OH$267.47
OK$278.64
OR$300.30
PA$268.76
PR$333.11
RI$331.51
SC$248.63
SD$277.97
TN$248.63
TX$278.64
UT$277.97
VA$268.76
VI$248.63
VT$331.51
WA$300.30
WI$267.47
WV$268.76
WY$277.97
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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