L5000 HCPCS code: Partial foot, shoe insert with longitudinal arch, toe filler
L5000 is the HCPCS Level II code for partial foot, shoe insert with longitudinal arch, toe filler. The 2026 Medicare DMEPOS fee schedule pays $618.56 to $999.36 depending on the state. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 2 per day on DME suppliers. Its average fee ranks 1 of 5 L50 codes (family range $680.19–$3,824.61).
Code details
| Field | Value |
|---|---|
| Section | L codes — Orthotic and prosthetic procedures and devices |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 38 — DMEPOS: orthotics, prosthetics, prosthetic devices and vision services |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 1982-01-01 |
| Last action effective | 1996-01-01 |
2026 Medicare DMEPOS fee schedule for L5000
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $618.56 | $999.36 | $824.75 | $618.56 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $719.69 | — |
| AL | — | $647.90 | — |
| AR | — | $824.75 | — |
| AZ | — | $735.74 | — |
| CA | — | $735.74 | — |
| CO | — | $618.56 | — |
| CT | — | $618.56 | — |
| DC | — | $682.33 | — |
| DE | — | $682.33 | — |
| FL | — | $647.90 | — |
| GA | — | $647.90 | — |
| HI | — | $769.62 | — |
| IA | — | $646.18 | — |
| ID | — | $618.56 | — |
| IL | — | $705.71 | — |
| IN | — | $705.71 | — |
| KS | — | $646.18 | — |
| KY | — | $647.90 | — |
| LA | — | $824.75 | — |
| MA | — | $618.56 | — |
| MD | — | $682.33 | — |
| ME | — | $618.56 | — |
| MI | — | $705.71 | — |
| MN | — | $705.71 | — |
| MO | — | $646.18 | — |
| MS | — | $647.90 | — |
| MT | — | $618.56 | — |
| NC | — | $647.90 | — |
| ND | — | $618.56 | — |
| NE | — | $646.18 | — |
| NH | — | $618.56 | — |
| NJ | — | $618.56 | — |
| NM | — | $824.75 | — |
| NV | — | $735.74 | — |
| NY | — | $618.56 | — |
| OH | — | $705.71 | — |
| OK | — | $824.75 | — |
| OR | — | $618.56 | — |
| PA | — | $682.33 | — |
| PR | — | $999.36 | — |
| RI | — | $618.56 | — |
| SC | — | $647.90 | — |
| SD | — | $618.56 | — |
| TN | — | $647.90 | — |
| TX | — | $824.75 | — |
| UT | — | $618.56 | — |
| VA | — | $682.33 | — |
| VI | — | $618.56 | — |
| VT | — | $618.56 | — |
| WA | — | $618.56 | — |
| WI | — | $705.71 | — |
| WV | — | $682.33 | — |
| WY | — | $618.56 | — |
How the L5000 fee compares
| Measure | Value |
|---|---|
| Rank among 5 L50 codes (lowest = 1) | 1 |
| Family fee range (average of state fees) | $680.19–$3,824.61 |
| Rural fee uplift | — |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 2 | Anatomic Consideration |
| outpatient hospital claims | 2 | Anatomic Consideration |
What changed for L5000
- 2026-01-01: Average state fee rose 2.0%: $666.85 to $680.19
- 1982-01-01: L5000 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code L5000?
L5000 is the HCPCS Level II code for partial foot, shoe insert with longitudinal arch, toe filler. Short descriptor: "Sho insert w arch toe filler".
How much does Medicare pay for L5000?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $618.56–$999.36. Rural fees can be higher.
Does Medicare cover L5000?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for L5000 change in 2026?
The average non-rural state fee moved from $666.85 in 2025 to $680.19 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L5000 can be billed per day?
2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).
Related L50 codes
- L5010 — Partial foot, molded socket, ankle height, with toe filler ($999.36–$1,971.82)
- L5020 — Partial foot, molded socket, tibial tubercle height, with toe filler ($1,380.46–$3,631.43)
- L5050 — Ankle, symes, molded socket, sach foot ($2,809.59–$3,807.08)
- L5060 — Ankle, symes, metal frame, molded leather socket, articulated ankle/foot ($1,022.60–$4,748.30)
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Next steps
- Run a reimbursement report for a device billed under L5000
- Watch L5000 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L5000
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.