L5100 HCPCS code: Below knee, molded socket, shin, sach foot
L5100 is the HCPCS Level II code for below knee, molded socket, shin, sach foot. The 2026 Medicare DMEPOS fee schedule pays $2,845.34 to $3,807.08 depending on the state. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 2 per day on DME suppliers. Its average fee ranks 1 of 4 L51 codes (family range $3,188.80–$5,338.11).
Code details
| Field | Value |
|---|---|
| Section | L codes — Orthotic and prosthetic procedures and devices |
| Coverage code | C — Carrier judgment |
| 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 L5100
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $2,845.34 | $3,807.08 | $3,793.78 | $2,845.34 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $3,178.64 | — |
| AL | — | $2,946.06 | — |
| AR | — | $3,480.09 | — |
| AZ | — | $3,291.35 | — |
| CA | — | $3,291.35 | — |
| CO | — | $2,845.34 | — |
| CT | — | $3,420.07 | — |
| DC | — | $2,926.84 | — |
| DE | — | $2,926.84 | — |
| FL | — | $2,946.06 | — |
| GA | — | $2,946.06 | — |
| HI | — | $3,398.88 | — |
| IA | — | $3,224.52 | — |
| ID | — | $3,420.57 | — |
| IL | — | $3,359.56 | — |
| IN | — | $3,359.56 | — |
| KS | — | $3,224.52 | — |
| KY | — | $2,946.06 | — |
| LA | — | $3,480.09 | — |
| MA | — | $3,420.07 | — |
| MD | — | $2,926.84 | — |
| ME | — | $3,420.07 | — |
| MI | — | $3,359.56 | — |
| MN | — | $3,359.56 | — |
| MO | — | $3,224.52 | — |
| MS | — | $2,946.06 | — |
| MT | — | $2,845.34 | — |
| NC | — | $2,946.06 | — |
| ND | — | $2,845.34 | — |
| NE | — | $3,224.52 | — |
| NH | — | $3,420.07 | — |
| NJ | — | $3,102.74 | — |
| NM | — | $3,480.09 | — |
| NV | — | $3,291.35 | — |
| NY | — | $3,102.74 | — |
| OH | — | $3,359.56 | — |
| OK | — | $3,480.09 | — |
| OR | — | $3,420.57 | — |
| PA | — | $2,926.84 | — |
| PR | — | $3,807.08 | — |
| RI | — | $3,420.07 | — |
| SC | — | $2,946.06 | — |
| SD | — | $2,845.34 | — |
| TN | — | $2,946.06 | — |
| TX | — | $3,480.09 | — |
| UT | — | $2,845.34 | — |
| VA | — | $2,926.84 | — |
| VI | — | $3,102.74 | — |
| VT | — | $3,420.07 | — |
| WA | — | $3,420.57 | — |
| WI | — | $3,359.56 | — |
| WV | — | $2,926.84 | — |
| WY | — | $2,845.34 | — |
How the L5100 fee compares
| Measure | Value |
|---|---|
| Rank among 4 L51 codes (lowest = 1) | 1 |
| Family fee range (average of state fees) | $3,188.80–$5,338.11 |
| 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 L5100
- 2026-01-01: Average state fee rose 2.0%: $3,126.27 to $3,188.80
- 1982-01-01: L5100 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 L5100?
L5100 is the HCPCS Level II code for below knee, molded socket, shin, sach foot. Short descriptor: "Molded socket shin sach foot".
How much does Medicare pay for L5100?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $2,845.34–$3,807.08. Rural fees can be higher.
Does Medicare cover L5100?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L5100 change in 2026?
The average non-rural state fee moved from $3,126.27 in 2025 to $3,188.80 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L5100 can be billed per day?
2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).
Related L51 codes
- L5105 — Below knee, plastic socket, joints and thigh lacer, sach foot ($4,252.97–$6,738.28)
- L5150 — Knee disarticulation (or through knee), molded socket, external knee joints, shin, sach foot ($4,299.18–$6,662.40)
- L5160 — Knee disarticulation (or through knee), molded socket, bent knee configuration, external knee joints, shin, sach foot ($4,676.12–$7,476.32)
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Next steps
- Run a reimbursement report for a device billed under L5100
- Watch L5100 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L5100
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.