L5200 HCPCS code: Above knee, molded socket, single axis constant friction knee, shin, sach foot
L5200 is the HCPCS Level II code for above knee, molded socket, single axis constant friction knee, shin, sach foot. The 2026 Medicare DMEPOS fee schedule pays $4,044.27 to $5,901.01 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. Medicare volume fell 19% from 2022 to 2024 (58 to 47 services). In 2024, 34 suppliers billed Medicare for L5200 (purchases), serving 47 beneficiaries. Its average fee ranks 3 of 7 L52 codes (family range $3,385.67–$7,497.99).
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 L5200
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $4,044.27 | $5,901.01 | $5,392.36 | $4,044.27 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $4,809.30 | — |
| AL | — | $4,478.06 | — |
| AR | — | $4,635.37 | — |
| AZ | — | $4,913.09 | — |
| CA | — | $4,913.09 | — |
| CO | — | $4,044.27 | — |
| CT | — | $5,128.50 | — |
| DC | — | $4,073.31 | — |
| DE | — | $4,073.31 | — |
| FL | — | $4,478.06 | — |
| GA | — | $4,478.06 | — |
| HI | — | $5,142.63 | — |
| IA | — | $4,318.11 | — |
| ID | — | $4,986.90 | — |
| IL | — | $4,476.02 | — |
| IN | — | $4,476.02 | — |
| KS | — | $4,318.11 | — |
| KY | — | $4,478.06 | — |
| LA | — | $4,635.37 | — |
| MA | — | $5,128.50 | — |
| MD | — | $4,073.31 | — |
| ME | — | $5,128.50 | — |
| MI | — | $4,476.02 | — |
| MN | — | $4,476.02 | — |
| MO | — | $4,318.11 | — |
| MS | — | $4,478.06 | — |
| MT | — | $4,044.27 | — |
| NC | — | $4,478.06 | — |
| ND | — | $4,044.27 | — |
| NE | — | $4,318.11 | — |
| NH | — | $5,128.50 | — |
| NJ | — | $4,046.07 | — |
| NM | — | $4,635.37 | — |
| NV | — | $4,913.09 | — |
| NY | — | $4,046.07 | — |
| OH | — | $4,476.02 | — |
| OK | — | $4,635.37 | — |
| OR | — | $4,986.90 | — |
| PA | — | $4,073.31 | — |
| PR | — | $5,901.01 | — |
| RI | — | $5,128.50 | — |
| SC | — | $4,478.06 | — |
| SD | — | $4,044.27 | — |
| TN | — | $4,478.06 | — |
| TX | — | $4,635.37 | — |
| UT | — | $4,044.27 | — |
| VA | — | $4,073.31 | — |
| VI | — | $4,046.07 | — |
| VT | — | $5,128.50 | — |
| WA | — | $4,986.90 | — |
| WI | — | $4,476.02 | — |
| WV | — | $4,073.31 | — |
| WY | — | $4,044.27 | — |
How the L5200 fee compares
| Measure | Value |
|---|---|
| Rank among 7 L52 codes (lowest = 1) | 3 |
| Family fee range (average of state fees) | $3,385.67–$7,497.99 |
| Rural fee uplift | — |
Who bills L5200 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 34 |
| Referring clinicians | 47 |
| Medicare beneficiaries | 47 |
| States with claims | 0 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 42 | 56 |
| 2023 | 36 | 53 |
| 2024 | 34 | 47 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L5200, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 58 | 56 | $3,881.20 | $3,063.59 |
| 2023 | 57 | 53 | $4,331.67 | $3,341.10 |
| 2024 | 47 | 47 | $4,440.98 | $3,477.71 |
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 L5200
- 2026-01-01: Average state fee rose 2.0%: $4,445.01 to $4,533.91
- 1982-01-01: L5200 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 L5200?
L5200 is the HCPCS Level II code for above knee, molded socket, single axis constant friction knee, shin, sach foot. Short descriptor: "Kne sing axis fric shin sach".
How much does Medicare pay for L5200?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $4,044.27–$5,901.01. Rural fees can be higher.
Does Medicare cover L5200?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for L5200?
Medicare policy articles that cite L5200 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 L5200 change in 2026?
The average non-rural state fee moved from $4,445.01 in 2025 to $4,533.91 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L5200 can be billed per day?
2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).
Related L52 codes
- L5210 — Above knee, short prosthesis, no knee joint ('stubbies'), with foot blocks, no ankle joints, each ($2,970.73–$5,520.31)
- L5220 — Above knee, short prosthesis, no knee joint ('stubbies'), with articulated ankle/foot, dynamically aligned, each ($3,376.78–$5,593.50)
- L5230 — Above knee, for proximal femoral focal deficiency, constant friction knee, shin, sach foot ($4,657.24–$7,081.06)
- L5250 — Hip disarticulation, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot ($6,352.07–$12,373.02)
- L5270 — Hip disarticulation, tilt table type; molded socket, locking hip joint, single axis constant friction knee, shin, sach foot ($4,875.36–$11,580.41)
- L5280 — Hemipelvectomy, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot ($6,233.46–$12,932.84)
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 L5200
- Watch L5200 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L5200
Sources: CMS HCPCS Level II release October 2026; 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.