L5160 HCPCS code: Knee disarticulation (or through knee), molded socket, bent knee configuration, external knee joints, shin, sach foot
L5160 is the HCPCS Level II code for knee disarticulation (or through knee), molded socket, bent knee configuration, external knee joints, shin, sach foot. The 2026 Medicare DMEPOS fee schedule pays $4,676.12 to $7,476.32 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 4 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 L5160
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $4,676.12 | $7,476.32 | $6,234.83 | $4,676.12 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $6,991.78 | — |
| AL | — | $4,676.12 | — |
| AR | — | $5,333.68 | — |
| AZ | — | $6,234.83 | — |
| CA | — | $6,234.83 | — |
| CO | — | $5,244.05 | — |
| CT | — | $5,157.17 | — |
| DC | — | $4,676.12 | — |
| DE | — | $4,676.12 | — |
| FL | — | $4,676.12 | — |
| GA | — | $4,676.12 | — |
| HI | — | $7,476.32 | — |
| IA | — | $5,332.74 | — |
| ID | — | $6,090.02 | — |
| IL | — | $5,787.25 | — |
| IN | — | $5,787.25 | — |
| KS | — | $5,332.74 | — |
| KY | — | $4,676.12 | — |
| LA | — | $5,333.68 | — |
| MA | — | $5,157.17 | — |
| MD | — | $4,676.12 | — |
| ME | — | $5,157.17 | — |
| MI | — | $5,787.25 | — |
| MN | — | $5,787.25 | — |
| MO | — | $5,332.74 | — |
| MS | — | $4,676.12 | — |
| MT | — | $5,244.05 | — |
| NC | — | $4,676.12 | — |
| ND | — | $5,244.05 | — |
| NE | — | $5,332.74 | — |
| NH | — | $5,157.17 | — |
| NJ | — | $4,676.12 | — |
| NM | — | $5,333.68 | — |
| NV | — | $6,234.83 | — |
| NY | — | $4,676.12 | — |
| OH | — | $5,787.25 | — |
| OK | — | $5,333.68 | — |
| OR | — | $6,090.02 | — |
| PA | — | $4,676.12 | — |
| PR | — | $6,852.74 | — |
| RI | — | $5,157.17 | — |
| SC | — | $4,676.12 | — |
| SD | — | $5,244.05 | — |
| TN | — | $4,676.12 | — |
| TX | — | $5,333.68 | — |
| UT | — | $5,244.05 | — |
| VA | — | $4,676.12 | — |
| VI | — | $4,676.12 | — |
| VT | — | $5,157.17 | — |
| WA | — | $6,090.02 | — |
| WI | — | $5,787.25 | — |
| WV | — | $4,676.12 | — |
| WY | — | $5,244.05 | — |
How the L5160 fee compares
| Measure | Value |
|---|---|
| Rank among 4 L51 codes (lowest = 1) | 4 |
| 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 |
Medicare policy articles for this code
- A52481: Orthopedic Footwear - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
- A52496: Lower Limb Prostheses - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (84 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| Q72.00 | Congenital complete absence of unspecified lower limb | 1 |
| Q72.01 | Congenital complete absence of right lower limb | 1 |
| Q72.02 | Congenital complete absence of left lower limb | 1 |
| Q72.03 | Congenital complete absence of lower limb, bilateral | 1 |
| Q72.30 | Congenital absence of unspecified foot and toe(s) | 1 |
| Q72.31 | Congenital absence of right foot and toe(s) | 1 |
| Q72.32 | Congenital absence of left foot and toe(s) | 1 |
| Q72.33 | Congenital absence of foot and toe(s), bilateral | 1 |
| Q72.70 | Split foot, unspecified lower limb | 1 |
| Q72.71 | Split foot, right lower limb | 1 |
Showing 10 of 84. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for L5160
- 2026-01-01: Average state fee rose 2.0%: $5,233.44 to $5,338.11
- 1982-01-01: L5160 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 L5160?
L5160 is the HCPCS Level II code for knee disarticulation (or through knee), molded socket, bent knee configuration, external knee joints, shin, sach foot. Short descriptor: "Mold socket bent knee shin s".
How much does Medicare pay for L5160?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $4,676.12–$7,476.32. Rural fees can be higher.
Does Medicare cover L5160?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for L5160?
Medicare policy articles that cite L5160 list 84 covered ICD-10-CM diagnosis codes across 2 articles. The most cited include Q72.00 (Congenital complete absence of unspecified lower limb), Q72.01 (Congenital complete absence of right lower limb), Q72.02 (Congenital complete absence of left lower limb). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
Did the Medicare fee for L5160 change in 2026?
The average non-rural state fee moved from $5,233.44 in 2025 to $5,338.11 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L5160 can be billed per day?
2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).
Related L51 codes
- L5100 — Below knee, molded socket, shin, sach foot ($2,845.34–$3,807.08)
- 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)
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under L5160
- Watch L5160 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L5160
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.