L5685 HCPCS code: Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each
L5685 is the HCPCS Level II code for addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each. The 2026 Medicare DMEPOS fee schedule pays $153.94 to $169.38 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 9% from 2022 to 2024 (34,772 to 31,763 services). In 2024, 1,998 suppliers billed Medicare for L5685 (purchases), serving 12,586 beneficiaries; Texas, California, Florida accounted for 22% of services. Its average fee ranks 10 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 | 2005-01-01 |
| Last action effective | 2005-01-01 |
2026 Medicare DMEPOS fee schedule for L5685
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $153.94 | $169.38 | $187.86 | $140.90 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $153.94 | — |
| AL | — | $158.57 | — |
| AR | — | $158.53 | — |
| AZ | — | $153.94 | — |
| CA | — | $153.94 | — |
| CO | — | $159.46 | — |
| CT | — | $153.94 | — |
| DC | — | $153.94 | — |
| DE | — | $153.94 | — |
| FL | — | $158.57 | — |
| GA | — | $158.57 | — |
| HI | — | $153.94 | — |
| IA | — | $156.97 | — |
| ID | — | $153.94 | — |
| IL | — | $157.74 | — |
| IN | — | $157.74 | — |
| KS | — | $156.97 | — |
| KY | — | $158.57 | — |
| LA | — | $158.53 | — |
| MA | — | $153.94 | — |
| MD | — | $153.94 | — |
| ME | — | $153.94 | — |
| MI | — | $157.74 | — |
| MN | — | $157.74 | — |
| MO | — | $156.97 | — |
| MS | — | $158.57 | — |
| MT | — | $159.46 | — |
| NC | — | $158.57 | — |
| ND | — | $159.46 | — |
| NE | — | $156.97 | — |
| NH | — | $153.94 | — |
| NJ | — | $153.94 | — |
| NM | — | $158.53 | — |
| NV | — | $153.94 | — |
| NY | — | $153.94 | — |
| OH | — | $157.74 | — |
| OK | — | $158.53 | — |
| OR | — | $153.94 | — |
| PA | — | $153.94 | — |
| PR | — | $169.38 | — |
| RI | — | $153.94 | — |
| SC | — | $158.57 | — |
| SD | — | $159.46 | — |
| TN | — | $158.57 | — |
| TX | — | $158.53 | — |
| UT | — | $159.46 | — |
| VA | — | $153.94 | — |
| VI | — | $169.38 | — |
| VT | — | $153.94 | — |
| WA | — | $153.94 | — |
| WI | — | $157.74 | — |
| WV | — | $153.94 | — |
| WY | — | $159.46 | — |
How the L5685 fee compares
| Measure | Value |
|---|---|
| Rank among 68 L56 codes (lowest = 1) | 10 |
| Family fee range (average of state fees) | $55.23–$7,528.87 |
| Rural fee uplift | — |
Who bills L5685 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 1,998 |
| Referring clinicians | 9,322 |
| Medicare beneficiaries | 12,586 |
| States with claims | 52 |
| Share of services in top 3 states (Texas, California, Florida) | 22% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 2,143 | 13,828 |
| 2023 | 2,098 | 13,349 |
| 2024 | 1,998 | 12,586 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L5685, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 34,772 | 13,828 | $134.20 | $102.31 |
| 2023 | 33,755 | 13,349 | $145.28 | $110.50 |
| 2024 | 31,763 | 12,586 | $149.72 | $114.21 |
States with the most L5685 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 3,042 | $116.57 |
| California | 2,428 | $113.62 |
| Florida | 1,625 | $116.86 |
| New York | 1,438 | $112.63 |
| Pennsylvania | 1,393 | $111.98 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 4 | Anatomic Consideration |
| outpatient hospital claims | 4 | Anatomic Consideration |
What changed for L5685
- 2026-01-01: Average state fee rose 2.0%: $153.86 to $156.94
- 2005-01-01: L5685 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 L5685?
L5685 is the HCPCS Level II code for addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each. Short descriptor: "Below knee sus/seal sleeve".
How much does Medicare pay for L5685?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $153.94–$169.38. Rural fees can be higher.
Does Medicare cover L5685?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L5685 change in 2026?
The average non-rural state fee moved from $153.86 in 2025 to $156.94 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L5685 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 L5685
- Watch L5685 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L5685
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.