L5585 HCPCS code: Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, prefabricated adjustable open end socket

L5585 is the HCPCS Level II code for preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, prefabricated adjustable open end socket. The 2026 Medicare DMEPOS fee schedule pays $3,132.31 to $4,568.53 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 22% from 2022 to 2024 (27 to 21 services). In 2024, 15 suppliers billed Medicare for L5585 (purchases), serving 20 beneficiaries. Its average fee ranks 12 of 13 L55 codes (family range $1,800.60–$5,634.97).

Code details

2026 Medicare DMEPOS fee schedule for L5585

How the L5585 fee compares

Who bills L5585 (2024)

Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.

Medicare utilization for L5585, 2022–2024

NCCI unit limits (MUE)

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:

Showing 10 of 84. The full list, non-covered diagnoses and CSV export are in Caduvo.

What changed for L5585

• 2026-01-01: Average state fee rose 2.0%: $3,438.17 to $3,506.93
• 1988-01-01: L5585 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 L5585?

L5585 is the HCPCS Level II code for preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, prefabricated adjustable open end socket. Short descriptor: "Prep ak ischial open end".

How much does Medicare pay for L5585?

Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $3,132.31–$4,568.53. Rural fees can be higher.

Does Medicare cover L5585?

Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.

Which diagnoses support coverage for L5585?

Medicare policy articles that cite L5585 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 L5585 change in 2026?

The average non-rural state fee moved from $3,438.17 in 2025 to $3,506.93 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.

How many units of L5585 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)
• L5580 — Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model ($1,738.32–$4,142.56)
• 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 L5585
• Watch L5585 for fee, coverage and descriptor changes
• Build a full Medicare revenue model for L5585

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.

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