L5331 HCPCS code: Hip disarticulation, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot
L5331 is the HCPCS Level II code for hip disarticulation, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot. The 2026 Medicare DMEPOS fee schedule pays $4,859.45 to $7,517.95 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 5 L53 codes (family range $3,222.48–$7,064.32).
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 | 2002-01-01 |
| Last action effective | 2002-01-01 |
2026 Medicare DMEPOS fee schedule for L5331
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $4,859.45 | $7,517.95 | $7,591.65 | $5,693.73 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $6,759.89 | — |
| AL | — | $6,219.83 | — |
| AR | — | $7,091.52 | — |
| AZ | — | $7,129.62 | — |
| CA | — | $7,129.62 | — |
| CO | — | $6,858.59 | — |
| CT | — | $6,313.06 | — |
| DC | — | $5,693.73 | — |
| DE | — | $5,693.73 | — |
| FL | — | $6,219.83 | — |
| GA | — | $6,219.83 | — |
| HI | — | $7,344.12 | — |
| IA | — | $6,801.84 | — |
| ID | — | $7,517.95 | — |
| IL | — | $6,443.12 | — |
| IN | — | $6,443.12 | — |
| KS | — | $6,801.84 | — |
| KY | — | $6,219.83 | — |
| LA | — | $7,091.52 | — |
| MA | — | $6,313.06 | — |
| MD | — | $5,693.73 | — |
| ME | — | $6,313.06 | — |
| MI | — | $6,443.12 | — |
| MN | — | $6,443.12 | — |
| MO | — | $6,801.84 | — |
| MS | — | $6,219.83 | — |
| MT | — | $6,858.59 | — |
| NC | — | $6,219.83 | — |
| ND | — | $6,858.59 | — |
| NE | — | $6,801.84 | — |
| NH | — | $6,313.06 | — |
| NJ | — | $5,693.73 | — |
| NM | — | $7,091.52 | — |
| NV | — | $7,129.62 | — |
| NY | — | $5,693.73 | — |
| OH | — | $6,443.12 | — |
| OK | — | $7,091.52 | — |
| OR | — | $7,517.95 | — |
| PA | — | $5,693.73 | — |
| PR | — | $4,859.45 | — |
| RI | — | $6,313.06 | — |
| SC | — | $6,219.83 | — |
| SD | — | $6,858.59 | — |
| TN | — | $6,219.83 | — |
| TX | — | $7,091.52 | — |
| UT | — | $6,858.59 | — |
| VA | — | $5,693.73 | — |
| VI | — | $5,693.73 | — |
| VT | — | $6,313.06 | — |
| WA | — | $7,517.95 | — |
| WI | — | $6,443.12 | — |
| WV | — | $5,693.73 | — |
| WY | — | $6,858.59 | — |
How the L5331 fee compares
| Measure | Value |
|---|---|
| Rank among 5 L53 codes (lowest = 1) | 4 |
| Family fee range (average of state fees) | $3,222.48–$7,064.32 |
| 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 L5331
- 2026-01-01: Average state fee rose 2.0%: $6,368.14 to $6,495.51
- 2002-01-01: L5331 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 L5331?
L5331 is the HCPCS Level II code for hip disarticulation, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot. Short descriptor: "Hip disart canadian sach ft".
How much does Medicare pay for L5331?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $4,859.45–$7,517.95. Rural fees can be higher.
Does Medicare cover L5331?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L5331 change in 2026?
The average non-rural state fee moved from $6,368.14 in 2025 to $6,495.51 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L5331 can be billed per day?
2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).
Related L53 codes
- L5301 — Below knee, molded socket, shin, sach foot, endoskeletal system ($2,810.90–$4,330.82)
- L5312 — Knee disarticulation (or through knee), molded socket, single axis knee, pylon, sach foot, endoskeletal system ($3,936.65–$5,384.23)
- L5321 — Above knee, molded socket, open end, sach foot, endoskeletal system, single axis knee ($4,023.73–$6,709.86)
- L5341 — Hemipelvectomy, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot ($6,039.09–$12,930.77)
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Next steps
- Run a reimbursement report for a device billed under L5331
- Watch L5331 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L5331
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.