L5220 HCPCS code: Above knee, short prosthesis, no knee joint ('stubbies'), with articulated ankle/foot, dynamically aligned, each
L5220 is the HCPCS Level II code for above knee, short prosthesis, no knee joint ('stubbies'), with articulated ankle/foot, dynamically aligned, each. The 2026 Medicare DMEPOS fee schedule pays $3,376.78 to $5,593.50 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 12% from 2022 to 2024 (138 to 122 services). In 2024, 59 suppliers billed Medicare for L5220 (purchases), serving 64 beneficiaries. Its average fee ranks 2 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 L5220
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $3,376.78 | $5,593.50 | $4,502.37 | $3,376.78 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $5,230.96 | — |
| AL | — | $3,376.78 | — |
| AR | — | $4,304.46 | — |
| AZ | — | $4,502.37 | — |
| CA | — | $4,502.37 | — |
| CO | — | $3,689.60 | — |
| CT | — | $3,465.98 | — |
| DC | — | $3,376.78 | — |
| DE | — | $3,376.78 | — |
| FL | — | $3,376.78 | — |
| GA | — | $3,376.78 | — |
| HI | — | $5,593.50 | — |
| IA | — | $3,733.10 | — |
| ID | — | $4,502.37 | — |
| IL | — | $3,914.91 | — |
| IN | — | $3,914.91 | — |
| KS | — | $3,733.10 | — |
| KY | — | $3,376.78 | — |
| LA | — | $4,304.46 | — |
| MA | — | $3,465.98 | — |
| MD | — | $3,376.78 | — |
| ME | — | $3,465.98 | — |
| MI | — | $3,914.91 | — |
| MN | — | $3,914.91 | — |
| MO | — | $3,733.10 | — |
| MS | — | $3,376.78 | — |
| MT | — | $3,689.60 | — |
| NC | — | $3,376.78 | — |
| ND | — | $3,689.60 | — |
| NE | — | $3,733.10 | — |
| NH | — | $3,465.98 | — |
| NJ | — | $3,615.38 | — |
| NM | — | $4,304.46 | — |
| NV | — | $4,502.37 | — |
| NY | — | $3,615.38 | — |
| OH | — | $3,914.91 | — |
| OK | — | $4,304.46 | — |
| OR | — | $4,502.37 | — |
| PA | — | $3,376.78 | — |
| PR | — | $5,329.90 | — |
| RI | — | $3,465.98 | — |
| SC | — | $3,376.78 | — |
| SD | — | $3,689.60 | — |
| TN | — | $3,376.78 | — |
| TX | — | $4,304.46 | — |
| UT | — | $3,689.60 | — |
| VA | — | $3,376.78 | — |
| VI | — | $3,615.38 | — |
| VT | — | $3,465.98 | — |
| WA | — | $4,502.37 | — |
| WI | — | $3,914.91 | — |
| WV | — | $3,376.78 | — |
| WY | — | $3,689.60 | — |
How the L5220 fee compares
| Measure | Value |
|---|---|
| Rank among 7 L52 codes (lowest = 1) | 2 |
| Family fee range (average of state fees) | $3,385.67–$7,497.99 |
| Rural fee uplift | — |
Who bills L5220 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 59 |
| Referring clinicians | 63 |
| Medicare beneficiaries | 64 |
| States with claims | 2 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 60 | 71 |
| 2023 | 72 | 84 |
| 2024 | 59 | 64 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L5220, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 138 | 71 | $3,240.14 | $2,517.85 |
| 2023 | 162 | 84 | $3,528.14 | $2,763.53 |
| 2024 | 122 | 64 | $3,532.20 | $2,745.82 |
States with the most L5220 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 16 | $2,980.49 |
| Georgia | 12 | $2,601.97 |
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
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 L5220
- 2026-01-01: Average state fee rose 2.0%: $3,776.68 to $3,852.21
- 1982-01-01: L5220 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 L5220?
L5220 is the HCPCS Level II code for above knee, short prosthesis, no knee joint ('stubbies'), with articulated ankle/foot, dynamically aligned, each. Short descriptor: "No knee joint with artic ali".
How much does Medicare pay for L5220?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $3,376.78–$5,593.50. Rural fees can be higher.
Does Medicare cover L5220?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for L5220?
Medicare policy articles that cite L5220 list 84 covered ICD-10-CM diagnosis codes across 1 article. 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 L5220 change in 2026?
The average non-rural state fee moved from $3,776.68 in 2025 to $3,852.21 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L5220 can be billed per day?
2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).
Related L52 codes
- L5200 — Above knee, molded socket, single axis constant friction knee, shin, sach foot ($4,044.27–$5,901.01)
- L5210 — Above knee, short prosthesis, no knee joint ('stubbies'), with foot blocks, no ankle joints, each ($2,970.73–$5,520.31)
- 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 L5220
- Watch L5220 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L5220
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.