L5580 HCPCS code: Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model
L5580 is the HCPCS Level II code for preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model. The 2026 Medicare DMEPOS fee schedule pays $1,738.32 to $4,142.56 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 38% from 2022 to 2024 (176 to 109 services). In 2024, 58 suppliers billed Medicare for L5580 (purchases), serving 104 beneficiaries. Its average fee ranks 10 of 13 L55 codes (family range $1,800.60–$5,634.97).
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 | 1986-01-01 |
| Last action effective | 1996-01-01 |
2026 Medicare DMEPOS fee schedule for L5580
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $1,738.32 | $4,142.56 | $3,850.59 | $2,887.94 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $3,874.07 | — |
| AL | — | $2,887.94 | — |
| AR | — | $3,455.29 | — |
| AZ | — | $3,829.74 | — |
| CA | — | $3,829.74 | — |
| CO | — | $3,534.00 | — |
| CT | — | $3,010.74 | — |
| DC | — | $2,887.94 | — |
| DE | — | $2,887.94 | — |
| FL | — | $2,887.94 | — |
| GA | — | $2,887.94 | — |
| HI | — | $4,142.56 | — |
| IA | — | $3,192.02 | — |
| ID | — | $3,188.52 | — |
| IL | — | $3,462.71 | — |
| IN | — | $3,462.71 | — |
| KS | — | $3,192.02 | — |
| KY | — | $2,887.94 | — |
| LA | — | $3,455.29 | — |
| MA | — | $3,010.74 | — |
| MD | — | $2,887.94 | — |
| ME | — | $3,010.74 | — |
| MI | — | $3,462.71 | — |
| MN | — | $3,462.71 | — |
| MO | — | $3,192.02 | — |
| MS | — | $2,887.94 | — |
| MT | — | $3,534.00 | — |
| NC | — | $2,887.94 | — |
| ND | — | $3,534.00 | — |
| NE | — | $3,192.02 | — |
| NH | — | $3,010.74 | — |
| NJ | — | $3,174.22 | — |
| NM | — | $3,455.29 | — |
| NV | — | $3,829.74 | — |
| NY | — | $3,174.22 | — |
| OH | — | $3,462.71 | — |
| OK | — | $3,455.29 | — |
| OR | — | $3,188.52 | — |
| PA | — | $2,887.94 | — |
| PR | — | $1,738.32 | — |
| RI | — | $3,010.74 | — |
| SC | — | $2,887.94 | — |
| SD | — | $3,534.00 | — |
| TN | — | $2,887.94 | — |
| TX | — | $3,455.29 | — |
| UT | — | $3,534.00 | — |
| VA | — | $2,887.94 | — |
| VI | — | $3,174.22 | — |
| VT | — | $3,010.74 | — |
| WA | — | $3,188.52 | — |
| WI | — | $3,462.71 | — |
| WV | — | $2,887.94 | — |
| WY | — | $3,534.00 | — |
How the L5580 fee compares
| Measure | Value |
|---|---|
| Rank among 13 L55 codes (lowest = 1) | 10 |
| Family fee range (average of state fees) | $1,800.60–$5,634.97 |
| Rural fee uplift | — |
Who bills L5580 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 58 |
| Referring clinicians | 97 |
| Medicare beneficiaries | 104 |
| States with claims | 2 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 96 | 165 |
| 2023 | 65 | 127 |
| 2024 | 58 | 104 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L5580, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 176 | 165 | $2,734.14 | $2,125.87 |
| 2023 | 139 | 127 | $2,934.07 | $2,287.18 |
| 2024 | 109 | 104 | $3,021.59 | $2,363.50 |
States with the most L5580 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 28 | $2,555.67 |
| Virginia | 16 | $2,155.97 |
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
- 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 L5580
- 2026-01-01: Average state fee rose 2.0%: $3,160.43 to $3,223.64
- 1986-01-01: L5580 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 L5580?
L5580 is the HCPCS Level II code for preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model. Short descriptor: "Prep ak ischial thermo mold".
How much does Medicare pay for L5580?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $1,738.32–$4,142.56. Rural fees can be higher.
Does Medicare cover L5580?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for L5580?
Medicare policy articles that cite L5580 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 L5580 change in 2026?
The average non-rural state fee moved from $3,160.43 in 2025 to $3,223.64 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L5580 can be billed per day?
2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).
Related L55 codes
- L5500 — Initial, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed ($1,572.33–$2,284.23)
- L5505 — Initial, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed ($2,129.35–$3,997.43)
- L5510 — Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model ($1,782.34–$3,045.67)
- L5520 — Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed ($1,760.53–$3,045.67)
- L5530 — Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model ($1,206.25–$3,245.65)
- L5535 — Preparatory, below knee 'ptb' type socket, non-alignable system, no cover, sach foot, prefabricated, adjustable open end socket ($2,076.09–$3,553.71)
- L5540 — Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, laminated socket, molded to model ($2,215.83–$3,140.85)
- L5560 — Preparatory, above knee- knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model ($2,379.43–$4,568.53)
- L5570 — Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed ($1,308.69–$3,428.66)
- L5585 — Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, prefabricated adjustable open end socket ($3,132.31–$4,568.53)
- L5590 — Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon no cover, sach foot, laminated socket, molded to model ($2,943.01–$4,568.53)
- L5595 — Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, thermoplastic or equal, molded to patient model ($4,929.43–$11,195.96)
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Next steps
- Run a reimbursement report for a device billed under L5580
- Watch L5580 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L5580
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.