L5987 — All lower extremity prosthesis, shank foot system with vertical loading pylon
HCPCS Level II L-code · short descriptor: “Shank ft w vert load pylon” · 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 L5987 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 2026-10-25; 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.
L5987 Medicare fee schedule (October 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $8645.70 to $9510.31 depending on state and rural status.
Former-CBA payment limits: ceiling $10550.87 · floor $7913.15
| State | Non-rural | Rural |
|---|---|---|
| AK | $8732.21 | — |
| AL | $8906.07 | — |
| AR | $8905.25 | — |
| AZ | $8645.73 | — |
| CA | $8645.73 | — |
| CO | $8955.19 | — |
| CT | $8645.70 | — |
| DC | $8645.71 | — |
| DE | $8645.71 | — |
| FL | $8906.07 | — |
| GA | $8906.07 | — |
| HI | $9337.39 | — |
| IA | $8814.60 | — |
| ID | $8645.73 | — |
| IL | $8858.10 | — |
| IN | $8858.10 | — |
| KS | $8814.60 | — |
| KY | $8906.07 | — |
| LA | $8905.25 | — |
| MA | $8645.70 | — |
| MD | $8645.71 | — |
| ME | $8645.70 | — |
| MI | $8858.10 | — |
| MN | $8858.10 | — |
| MO | $8814.60 | — |
| MS | $8906.07 | — |
| MT | $8955.19 | — |
| NC | $8906.07 | — |
| ND | $8955.19 | — |
| NE | $8814.60 | — |
| NH | $8645.70 | — |
| NJ | $8645.70 | — |
| NM | $8905.25 | — |
| NV | $8645.73 | — |
| NY | $8645.70 | — |
| OH | $8858.10 | — |
| OK | $8905.25 | — |
| OR | $8645.73 | — |
| PA | $8645.71 | — |
| PR | $9510.31 | — |
| RI | $8645.70 | — |
| SC | $8906.07 | — |
| SD | $8955.19 | — |
| TN | $8906.07 | — |
| TX | $8905.25 | — |
| UT | $8955.19 | — |
| VA | $8645.71 | — |
| VI | $9510.31 | — |
| VT | $8645.70 | — |
| WA | $8645.73 | — |
| WI | $8858.10 | — |
| WV | $8645.71 | — |
| WY | $8955.19 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps L5987 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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