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L5990 — Addition to lower extremity prosthesis, user adjustable heel height

HCPCS Level II L-code · short descriptor: “User adjustable heel height”

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.

L5990 Medicare fee schedule (April 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $2180.41 to $2398.40 depending on state and rural status.

Former-CBA payment limits: ceiling $2660.84 · floor $1995.63

StateNon-ruralRural
AK$2180.41
AL$2246.04
AR$2245.81
AZ$2180.41
CA$2180.41
CO$2258.41
CT$2180.41
DC$2180.41
DE$2180.41
FL$2246.04
GA$2246.04
HI$2180.41
IA$2222.94
ID$2180.41
IL$2233.87
IN$2233.87
KS$2222.94
KY$2246.04
LA$2245.81
MA$2180.41
MD$2180.41
ME$2180.41
MI$2233.87
MN$2233.87
MO$2222.94
MS$2246.04
MT$2258.41
NC$2246.04
ND$2258.41
NE$2222.94
NH$2180.41
NJ$2180.41
NM$2245.81
NV$2180.41
NY$2180.41
OH$2233.87
OK$2245.81
OR$2180.41
PA$2180.41
PR$2398.40
RI$2180.41
SC$2246.04
SD$2258.41
TN$2246.04
TX$2245.81
UT$2258.41
VA$2180.41
VI$2398.40
VT$2180.41
WA$2180.41
WI$2233.87
WV$2180.41
WY$2258.41
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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