L5785 HCPCS code: Addition, exoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)
L5785 is the HCPCS Level II code for addition, exoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal). The 2026 Medicare DMEPOS fee schedule pays $636.06 to $848.09 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 12% from 2022 to 2024 (368 to 325 services). In 2024, 221 suppliers billed Medicare for L5785 (purchases), serving 293 beneficiaries; California, Texas, New York accounted for 59% of services. Its average fee ranks 4 of 25 L57 codes (family range $505.38–$5,985.47).
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 | 1988-01-01 |
| Last action effective | 1996-01-01 |
2026 Medicare DMEPOS fee schedule for L5785
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $636.06 | $848.09 | $848.09 | $636.06 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $678.67 | — |
| AL | — | $787.90 | — |
| AR | — | $709.19 | — |
| AZ | — | $672.47 | — |
| CA | — | $672.47 | — |
| CO | — | $636.06 | — |
| CT | — | $848.09 | — |
| DC | — | $636.06 | — |
| DE | — | $636.06 | — |
| FL | — | $787.90 | — |
| GA | — | $787.90 | — |
| HI | — | $725.69 | — |
| IA | — | $636.07 | — |
| ID | — | $759.84 | — |
| IL | — | $636.06 | — |
| IN | — | $636.06 | — |
| KS | — | $636.07 | — |
| KY | — | $787.90 | — |
| LA | — | $709.19 | — |
| MA | — | $848.09 | — |
| MD | — | $636.06 | — |
| ME | — | $848.09 | — |
| MI | — | $636.06 | — |
| MN | — | $636.06 | — |
| MO | — | $636.07 | — |
| MS | — | $787.90 | — |
| MT | — | $636.06 | — |
| NC | — | $787.90 | — |
| ND | — | $636.06 | — |
| NE | — | $636.07 | — |
| NH | — | $848.09 | — |
| NJ | — | $636.06 | — |
| NM | — | $709.19 | — |
| NV | — | $672.47 | — |
| NY | — | $636.06 | — |
| OH | — | $636.06 | — |
| OK | — | $709.19 | — |
| OR | — | $759.84 | — |
| PA | — | $636.06 | — |
| PR | — | $713.83 | — |
| RI | — | $848.09 | — |
| SC | — | $787.90 | — |
| SD | — | $636.06 | — |
| TN | — | $787.90 | — |
| TX | — | $709.19 | — |
| UT | — | $636.06 | — |
| VA | — | $636.06 | — |
| VI | — | $636.06 | — |
| VT | — | $848.09 | — |
| WA | — | $759.84 | — |
| WI | — | $636.06 | — |
| WV | — | $636.06 | — |
| WY | — | $636.06 | — |
How the L5785 fee compares
| Measure | Value |
|---|---|
| Rank among 25 L57 codes (lowest = 1) | 4 |
| Family fee range (average of state fees) | $505.38–$5,985.47 |
| Rural fee uplift | — |
Who bills L5785 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 221 |
| Referring clinicians | 277 |
| Medicare beneficiaries | 293 |
| States with claims | 8 |
| Share of services in top 3 states (California, Texas, New York) | 59% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 238 | 334 |
| 2023 | 209 | 288 |
| 2024 | 221 | 293 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L5785, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 368 | 334 | $589.78 | $455.08 |
| 2023 | 320 | 288 | $644.41 | $497.81 |
| 2024 | 325 | 293 | $656.22 | $512.33 |
States with the most L5785 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 40 | $489.73 |
| Texas | 26 | $529.03 |
| New York | 22 | $477.44 |
| Illinois | 14 | $477.44 |
| Wisconsin | 13 | $440.71 |
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 L5785
- 2026-01-01: Average state fee rose 2.0%: $689.13 to $702.91
- 1988-01-01: L5785 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 L5785?
L5785 is the HCPCS Level II code for addition, exoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal). Short descriptor: "Exoskeletal bk ultralt mater".
How much does Medicare pay for L5785?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $636.06–$848.09. Rural fees can be higher.
Does Medicare cover L5785?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L5785 change in 2026?
The average non-rural state fee moved from $689.13 in 2025 to $702.91 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L5785 can be billed per day?
2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).
Related L57 codes
- L5700 — Replacement, socket, below knee, molded to patient model ($3,415.10–$4,470.21)
- L5701 — Replacement, socket, above knee/knee disarticulation, including attachment plate, molded to patient model ($4,212.11–$5,550.13)
- L5702 — Replacement, socket, hip disarticulation, including hip joint, molded to patient model ($5,328.96–$7,985.48)
- L5703 — Ankle, symes, molded to patient model, socket without solid ankle cushion heel (sach) foot, replacement only ($2,560.96–$3,474.01)
- L5704 — Custom shaped protective cover, below knee ($656.17–$808.71)
- L5705 — Custom shaped protective cover, above knee ($1,172.40–$1,445.02)
- L5706 — Custom shaped protective cover, knee disarticulation ($1,149.30–$1,416.51)
- L5707 — Custom shaped protective cover, hip disarticulation ($1,515.21–$1,867.45)
- L5710 — Addition, exoskeletal knee-shin system, single axis, manual lock ($440.31–$838.03)
- L5711 — Additions exoskeletal knee-shin system, single axis, manual lock, ultra-light material ($628.18–$984.73)
- L5712 — Addition, exoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee) ($527.52–$973.68)
- L5714 — Addition, exoskeletal knee-shin system, single axis, variable friction swing phase control ($255.56–$626.05)
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Next steps
- Run a reimbursement report for a device billed under L5785
- Watch L5785 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L5785
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.