MyMedi-AI

L5978 — All lower extremity prostheses, foot, multiaxial ankle/foot

HCPCS Level II L-code · short descriptor: “Ft prosth multiaxial ankl/ft”

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
MUE unit limit
2
Status
Active (HCPCS Level II October 2026)

Prior authorization

Not on the Medicare required-PA list (CMS Required Prior Authorization List — 74 items in force on 2026-10-25; 8 more from 2026-10-28; sources: CMS list updated 2026-01-13, CMS-6109-N (91 FR 47972)). 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 (CMS Required F2F & WOPD List — 83 items in force on 2026-10-25; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). The standard written order must reach the supplier before claim submission.

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

L5978 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $228.16 to $652.23 depending on state and rural status.

Former-CBA payment limits: ceiling $476.36 · floor $357.27

StateNon-ruralRural
AK$609.95—
AL$357.27—
AR$416.66—
AZ$476.36—
CA$476.36—
CO$357.27—
CT$454.71—
DC$357.27—
DE$357.27—
FL$357.27—
GA$357.27—
HI$652.23—
IA$476.36—
ID$433.15—
IL$383.44—
IN$383.44—
KS$476.36—
KY$357.27—
LA$416.66—
MA$454.71—
MD$357.27—
ME$454.71—
MI$383.44—
MN$383.44—
MO$476.36—
MS$357.27—
MT$357.27—
NC$357.27—
ND$357.27—
NE$476.36—
NH$454.71—
NJ$357.27—
NM$416.66—
NV$476.36—
NY$357.27—
OH$383.44—
OK$416.66—
OR$433.15—
PA$357.27—
PR$228.16—
RI$454.71—
SC$357.27—
SD$357.27—
TN$357.27—
TX$416.66—
UT$357.27—
VA$357.27—
VI$357.27—
VT$454.71—
WA$433.15—
WI$383.44—
WV$357.27—
WY$357.27—
Amounts are the Medicare DMEPOS fee-schedule allowables effective October 2026 (CMS DMEPOS Fee Schedule October 2026 (DME26-D)). 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.

Unit limit (MUE)

Medicare's Medically Unlikely Edit caps L5978 at 2 units per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: Anatomic Consideration.

Common denial codes to watch

Related L-codes

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