L5636 HCPCS code: Addition to lower extremity, symes type, medial opening socket
L5636 is the HCPCS Level II code for addition to lower extremity, symes type, medial opening socket. The 2026 Medicare DMEPOS fee schedule pays $102.40 to $415.91 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 23% from 2022 to 2024 (75 to 58 services). In 2024, 48 suppliers billed Medicare for L5636 (purchases), serving 52 beneficiaries. Its average fee ranks 17 of 68 L56 codes (family range $55.23–$7,528.87).
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 |
2026 Medicare DMEPOS fee schedule for L5636
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $102.40 | $415.91 | $415.91 | $311.94 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $310.77 | — |
| AL | — | $311.94 | — |
| AR | — | $311.94 | — |
| AZ | — | $311.94 | — |
| CA | — | $311.94 | — |
| CO | — | $415.91 | — |
| CT | — | $415.91 | — |
| DC | — | $311.94 | — |
| DE | — | $311.94 | — |
| FL | — | $311.94 | — |
| GA | — | $311.94 | — |
| HI | — | $332.38 | — |
| IA | — | $315.77 | — |
| ID | — | $384.84 | — |
| IL | — | $316.91 | — |
| IN | — | $316.91 | — |
| KS | — | $315.77 | — |
| KY | — | $311.94 | — |
| LA | — | $311.94 | — |
| MA | — | $415.91 | — |
| MD | — | $311.94 | — |
| ME | — | $415.91 | — |
| MI | — | $316.91 | — |
| MN | — | $316.91 | — |
| MO | — | $315.77 | — |
| MS | — | $311.94 | — |
| MT | — | $415.91 | — |
| NC | — | $311.94 | — |
| ND | — | $415.91 | — |
| NE | — | $315.77 | — |
| NH | — | $415.91 | — |
| NJ | — | $415.91 | — |
| NM | — | $311.94 | — |
| NV | — | $311.94 | — |
| NY | — | $415.91 | — |
| OH | — | $316.91 | — |
| OK | — | $311.94 | — |
| OR | — | $384.84 | — |
| PA | — | $311.94 | — |
| PR | — | $102.40 | — |
| RI | — | $415.91 | — |
| SC | — | $311.94 | — |
| SD | — | $415.91 | — |
| TN | — | $311.94 | — |
| TX | — | $311.94 | — |
| UT | — | $415.91 | — |
| VA | — | $311.94 | — |
| VI | — | $415.91 | — |
| VT | — | $415.91 | — |
| WA | — | $384.84 | — |
| WI | — | $316.91 | — |
| WV | — | $311.94 | — |
| WY | — | $415.91 | — |
How the L5636 fee compares
| Measure | Value |
|---|---|
| Rank among 68 L56 codes (lowest = 1) | 17 |
| Family fee range (average of state fees) | $55.23–$7,528.87 |
| Rural fee uplift | — |
Who bills L5636 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 48 |
| Referring clinicians | 51 |
| Medicare beneficiaries | 52 |
| States with claims | 1 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 67 | 73 |
| 2023 | 62 | 64 |
| 2024 | 48 | 52 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L5636, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 75 | 73 | $279.07 | $215.07 |
| 2023 | 67 | 64 | $307.60 | $229.30 |
| 2024 | 58 | 52 | $308.61 | $241.95 |
States with the most L5636 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 11 | $234.14 |
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 L5636
- 2026-01-01: Average state fee rose 2.0%: $336.03 to $342.75
- 1986-01-01: L5636 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 L5636?
L5636 is the HCPCS Level II code for addition to lower extremity, symes type, medial opening socket. Short descriptor: "Symes type medial opening so".
How much does Medicare pay for L5636?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $102.40–$415.91. Rural fees can be higher.
Does Medicare cover L5636?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L5636 change in 2026?
The average non-rural state fee moved from $336.03 in 2025 to $342.75 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L5636 can be billed per day?
2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).
Related L56 codes
- L5600 — Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, laminated socket, molded to patient model ($5,443.57–$10,073.55)
- L5610 — Addition to lower extremity, endoskeletal system, above knee, hydracadence system ($2,534.66–$3,807.08)
- L5611 — Addition to lower extremity, endoskeletal system, above knee - knee disarticulation, 4 bar linkage, with friction swing phase control ($1,972.47–$2,747.18)
- L5613 — Addition to lower extremity, endoskeletal system, above knee-knee disarticulation, 4 bar linkage, with hydraulic swing phase control ($2,522.22–$4,561.30)
- L5614 — Addition to lower extremity, exoskeletal system, above knee-knee disarticulation, 4 bar linkage, with pneumatic swing phase control ($2,028.06–$2,230.84)
- L5615 — Addition, endoskeletal knee-shin system, 4 bar linkage or multiaxial, fluid swing and stance phase control ($6,603.89–$9,833.55)
- L5616 — Addition to lower extremity, endoskeletal system, above knee, universal multiplex system, friction swing phase control ($1,427.66–$2,216.96)
- L5617 — Addition to lower extremity, quick change self-aligning unit, above knee or below knee, each ($672.42–$739.74)
- L5618 — Addition to lower extremity, test socket, symes ($319.44–$459.08)
- L5620 — Addition to lower extremity, test socket, below knee ($340.36–$483.98)
- L5622 — Addition to lower extremity, test socket, knee disarticulation ($443.82–$1,237.32)
- L5624 — Addition to lower extremity, test socket, above knee ($445.08–$677.51)
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Next steps
- Run a reimbursement report for a device billed under L5636
- Watch L5636 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L5636
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.