L5980 — All lower extremity prostheses, flex foot system

HCPCS Level II L-code · short descriptor: “Flex foot system” · 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)
Face-to-face & WOPD: Not on the required list
MUE unit limit: 2
Status: Active (HCPCS Level II October 2026)

Prior authorization

PA REQUIRED L5980 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.

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 2026-10-26; 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.

L5980 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $4539.15 to $6928.90 depending on state and rural status.

Former-CBA payment limits: ceiling $6052.20 · floor $4539.15

State	Non-rural	Rural
AK	$5429.04	—
AL	$4539.15	—
AR	$4801.22	—
AZ	$5166.71	—
CA	$5166.71	—
CO	$6052.20	—
CT	$5328.59	—
DC	$4539.15	—
DE	$4539.15	—
FL	$4539.15	—
GA	$4539.15	—
HI	$5805.29	—
IA	$5051.89	—
ID	$4963.11	—
IL	$4677.59	—
IN	$4677.59	—
KS	$5051.89	—
KY	$4539.15	—
LA	$4801.22	—
MA	$5328.59	—
MD	$4539.15	—
ME	$5328.59	—
MI	$4677.59	—
MN	$4677.59	—
MO	$5051.89	—
MS	$4539.15	—
MT	$6052.20	—
NC	$4539.15	—
ND	$6052.20	—
NE	$5051.89	—
NH	$5328.59	—
NJ	$5960.65	—
NM	$4801.22	—
NV	$5166.71	—
NY	$5960.65	—
OH	$4677.59	—
OK	$4801.22	—
OR	$4963.11	—
PA	$4539.15	—
PR	$6928.90	—
RI	$5328.59	—
SC	$4539.15	—
SD	$6052.20	—
TN	$4539.15	—
TX	$4801.22	—
UT	$6052.20	—
VA	$4539.15	—
VI	$5960.63	—
VT	$5328.59	—
WA	$4963.11	—
WI	$4677.59	—
WV	$4539.15	—
WY	$6052.20	—

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 L5980 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

CO-50 medical necessity CO-197 no prior auth CO-151 frequency/units

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