L5699 HCPCS code: All lower extremity prostheses, shoulder harness
L5699 is the HCPCS Level II code for all lower extremity prostheses, shoulder harness. The 2026 Medicare DMEPOS fee schedule pays $102.32 to $424.90 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. Its average fee ranks 15 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 |
| Last action effective | 1996-01-01 |
2026 Medicare DMEPOS fee schedule for L5699
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $102.32 | $424.90 | $304.35 | $228.26 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $397.36 | — |
| AL | — | $289.51 | — |
| AR | — | $228.26 | — |
| AZ | — | $304.35 | — |
| CA | — | $304.35 | — |
| CO | — | $228.26 | — |
| CT | — | $295.29 | — |
| DC | — | $228.26 | — |
| DE | — | $228.26 | — |
| FL | — | $289.51 | — |
| GA | — | $289.51 | — |
| HI | — | $424.90 | — |
| IA | — | $228.26 | — |
| ID | — | $300.95 | — |
| IL | — | $251.10 | — |
| IN | — | $251.10 | — |
| KS | — | $228.26 | — |
| KY | — | $289.51 | — |
| LA | — | $228.26 | — |
| MA | — | $295.29 | — |
| MD | — | $228.26 | — |
| ME | — | $295.29 | — |
| MI | — | $251.10 | — |
| MN | — | $251.10 | — |
| MO | — | $228.26 | — |
| MS | — | $289.51 | — |
| MT | — | $228.26 | — |
| NC | — | $289.51 | — |
| ND | — | $228.26 | — |
| NE | — | $228.26 | — |
| NH | — | $295.29 | — |
| NJ | — | $232.85 | — |
| NM | — | $228.26 | — |
| NV | — | $304.35 | — |
| NY | — | $232.85 | — |
| OH | — | $251.10 | — |
| OK | — | $228.26 | — |
| OR | — | $300.95 | — |
| PA | — | $228.26 | — |
| PR | — | $102.32 | — |
| RI | — | $295.29 | — |
| SC | — | $289.51 | — |
| SD | — | $228.26 | — |
| TN | — | $289.51 | — |
| TX | — | $228.26 | — |
| UT | — | $228.26 | — |
| VA | — | $228.26 | — |
| VI | — | $232.85 | — |
| VT | — | $295.29 | — |
| WA | — | $300.95 | — |
| WI | — | $251.10 | — |
| WV | — | $228.26 | — |
| WY | — | $228.26 | — |
How the L5699 fee compares
| Measure | Value |
|---|---|
| Rank among 68 L56 codes (lowest = 1) | 15 |
| Family fee range (average of state fees) | $55.23–$7,528.87 |
| Rural fee uplift | — |
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 L5699
- 2026-01-01: Average state fee rose 2.0%: $255.77 to $260.89
- 1986-01-01: L5699 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 L5699?
L5699 is the HCPCS Level II code for all lower extremity prostheses, shoulder harness. Short descriptor: "Shoulder harness".
How much does Medicare pay for L5699?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $102.32–$424.90. Rural fees can be higher.
Does Medicare cover L5699?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L5699 change in 2026?
The average non-rural state fee moved from $255.77 in 2025 to $260.89 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L5699 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 L5699
- Watch L5699 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L5699
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.