MyMedi-AI

L5979 — All lower extremity prosthesis, multi-axial ankle, dynamic response foot, one piece system

HCPCS Level II L-code · short descriptor: “Multi-axial ankle/ft prosth”

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.

L5979 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $2793.44 to $3724.58 depending on state and rural status.

Former-CBA payment limits: ceiling $3724.58 · floor $2793.44

StateNon-ruralRural
AK$3373.57—
AL$2793.44—
AR$2793.44—
AZ$3690.19—
CA$3690.19—
CO$3381.42—
CT$2899.67—
DC$2866.86—
DE$2866.86—
FL$2793.44—
GA$2793.44—
HI$3373.57—
IA$3724.58—
ID$3690.19—
IL$3070.11—
IN$3070.11—
KS$3724.58—
KY$2793.44—
LA$2793.44—
MA$2899.67—
MD$2866.86—
ME$2899.67—
MI$3070.11—
MN$3070.11—
MO$3724.58—
MS$2793.44—
MT$3381.42—
NC$2793.44—
ND$3381.42—
NE$3724.58—
NH$2899.67—
NJ$2793.44—
NM$2793.44—
NV$3690.19—
NY$2793.44—
OH$3070.11—
OK$2793.44—
OR$3690.19—
PA$2866.86—
PR$3416.38—
RI$2899.67—
SC$2793.44—
SD$3381.42—
TN$2793.44—
TX$2793.44—
UT$3381.42—
VA$2866.86—
VI$2793.44—
VT$2899.67—
WA$3690.19—
WI$3070.11—
WV$2866.86—
WY$3381.42—
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 L5979 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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