L5679 HCPCS code: Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, not for use with locking mechanism
L5679 is the HCPCS Level II code for addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, not for use with locking mechanism. The 2026 Medicare DMEPOS fee schedule pays $633.27 to $997.21 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 4 per day on DME suppliers. Medicare volume fell 7% from 2022 to 2024 (36,218 to 33,562 services). In 2024, 2,030 suppliers billed Medicare for L5679 (purchases), serving 14,304 beneficiaries; Texas, California, Florida accounted for 22% of services. Its average fee ranks 45 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 | 2004-01-01 |
| Last action effective | 2025-10-01 |
2026 Medicare DMEPOS fee schedule for L5679
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $633.27 | $997.21 | $908.93 | $681.70 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $854.21 | — |
| AL | — | $725.39 | — |
| AR | — | $747.37 | — |
| AZ | — | $799.39 | — |
| CA | — | $799.39 | — |
| CO | — | $772.95 | — |
| CT | — | $804.82 | — |
| DC | — | $716.74 | — |
| DE | — | $716.74 | — |
| FL | — | $725.39 | — |
| GA | — | $725.39 | — |
| HI | — | $997.21 | — |
| IA | — | $764.25 | — |
| ID | — | $730.77 | — |
| IL | — | $806.49 | — |
| IN | — | $806.49 | — |
| KS | — | $764.25 | — |
| KY | — | $725.39 | — |
| LA | — | $747.37 | — |
| MA | — | $804.82 | — |
| MD | — | $716.74 | — |
| ME | — | $804.82 | — |
| MI | — | $806.49 | — |
| MN | — | $806.49 | — |
| MO | — | $764.25 | — |
| MS | — | $725.39 | — |
| MT | — | $772.95 | — |
| NC | — | $725.39 | — |
| ND | — | $772.95 | — |
| NE | — | $764.25 | — |
| NH | — | $804.82 | — |
| NJ | — | $681.70 | — |
| NM | — | $747.37 | — |
| NV | — | $799.39 | — |
| NY | — | $681.70 | — |
| OH | — | $806.49 | — |
| OK | — | $747.37 | — |
| OR | — | $730.77 | — |
| PA | — | $716.74 | — |
| PR | — | $633.27 | — |
| RI | — | $804.82 | — |
| SC | — | $725.39 | — |
| SD | — | $772.95 | — |
| TN | — | $725.39 | — |
| TX | — | $747.37 | — |
| UT | — | $772.95 | — |
| VA | — | $716.74 | — |
| VI | — | $683.52 | — |
| VT | — | $804.82 | — |
| WA | — | $730.77 | — |
| WI | — | $806.49 | — |
| WV | — | $716.74 | — |
| WY | — | $772.95 | — |
How the L5679 fee compares
| Measure | Value |
|---|---|
| Rank among 68 L56 codes (lowest = 1) | 45 |
| Family fee range (average of state fees) | $55.23–$7,528.87 |
| Rural fee uplift | — |
Who bills L5679 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 2,030 |
| Referring clinicians | 10,079 |
| Medicare beneficiaries | 14,304 |
| States with claims | 51 |
| Share of services in top 3 states (Texas, California, Florida) | 22% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 2,157 | 15,568 |
| 2023 | 2,139 | 15,000 |
| 2024 | 2,030 | 14,304 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L5679, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 36,218 | 15,568 | $645.08 | $496.65 |
| 2023 | 35,081 | 15,000 | $698.21 | $536.02 |
| 2024 | 33,562 | 14,304 | $719.74 | $552.90 |
States with the most L5679 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 3,154 | $552.00 |
| California | 2,347 | $594.01 |
| Florida | 1,940 | $539.60 |
| Pennsylvania | 1,595 | $524.00 |
| New York | 1,587 | $507.88 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 4 | Nature of Equipment |
| outpatient hospital claims | 4 | Nature of Equipment |
Medicare policy articles for this code
- A52496: Lower Limb Prostheses - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
What changed for L5679
- October 2025: Descriptor revised (Was: Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism)
- 2026-01-01: Average state fee rose 2.0%: $745.93 to $760.85
- 2025-10-01: Last CMS action: long description changed
- 2004-01-01: L5679 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 L5679?
L5679 is the HCPCS Level II code for addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, not for use with locking mechanism. Short descriptor: "Socket insert w/o lock mech".
How much does Medicare pay for L5679?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $633.27–$997.21. Rural fees can be higher.
Does Medicare cover L5679?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L5679 change in 2026?
The average non-rural state fee moved from $745.93 in 2025 to $760.85 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L5679 can be billed per day?
4 on DME suppliers; 4 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)
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 L5679
- Watch L5679 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L5679
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.