L5790 HCPCS code: Addition, exoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)
L5790 is the HCPCS Level II code for addition, exoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal). The 2026 Medicare DMEPOS fee schedule pays $880.26 to $1,173.68 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 rose 10% from 2022 to 2024 (79 to 87 services). In 2024, 54 suppliers billed Medicare for L5790 (purchases), serving 75 beneficiaries. Its average fee ranks 7 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 L5790
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $880.26 | $1,173.68 | $1,173.68 | $880.26 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $1,090.59 | — |
| AL | — | $880.26 | — |
| AR | — | $1,173.68 | — |
| AZ | — | $1,082.72 | — |
| CA | — | $1,082.72 | — |
| CO | — | $880.26 | — |
| CT | — | $1,173.68 | — |
| DC | — | $880.26 | — |
| DE | — | $880.26 | — |
| FL | — | $880.26 | — |
| GA | — | $880.26 | — |
| HI | — | $1,166.13 | — |
| IA | — | $904.45 | — |
| ID | — | $914.89 | — |
| IL | — | $917.99 | — |
| IN | — | $917.99 | — |
| KS | — | $904.45 | — |
| KY | — | $880.26 | — |
| LA | — | $1,173.68 | — |
| MA | — | $1,173.68 | — |
| MD | — | $880.26 | — |
| ME | — | $1,173.68 | — |
| MI | — | $917.99 | — |
| MN | — | $917.99 | — |
| MO | — | $904.45 | — |
| MS | — | $880.26 | — |
| MT | — | $880.26 | — |
| NC | — | $880.26 | — |
| ND | — | $880.26 | — |
| NE | — | $904.45 | — |
| NH | — | $1,173.68 | — |
| NJ | — | $880.26 | — |
| NM | — | $1,173.68 | — |
| NV | — | $1,082.72 | — |
| NY | — | $880.26 | — |
| OH | — | $917.99 | — |
| OK | — | $1,173.68 | — |
| OR | — | $914.89 | — |
| PA | — | $880.26 | — |
| PR | — | $1,142.13 | — |
| RI | — | $1,173.68 | — |
| SC | — | $880.26 | — |
| SD | — | $880.26 | — |
| TN | — | $880.26 | — |
| TX | — | $1,173.68 | — |
| UT | — | $880.26 | — |
| VA | — | $880.26 | — |
| VI | — | $880.26 | — |
| VT | — | $1,173.68 | — |
| WA | — | $914.89 | — |
| WI | — | $917.99 | — |
| WV | — | $880.26 | — |
| WY | — | $880.26 | — |
How the L5790 fee compares
| Measure | Value |
|---|---|
| Rank among 25 L57 codes (lowest = 1) | 7 |
| Family fee range (average of state fees) | $505.38–$5,985.47 |
| Rural fee uplift | — |
Who bills L5790 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 54 |
| Referring clinicians | 69 |
| Medicare beneficiaries | 75 |
| States with claims | 0 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 58 | 66 |
| 2023 | 50 | 65 |
| 2024 | 54 | 75 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L5790, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 79 | 66 | $808.00 | $635.57 |
| 2023 | 78 | 65 | $900.64 | $697.62 |
| 2024 | 87 | 75 | $899.21 | $698.56 |
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 L5790
- 2026-01-01: Average state fee rose 2.0%: $955.86 to $974.98
- 1988-01-01: L5790 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 L5790?
L5790 is the HCPCS Level II code for addition, exoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal). Short descriptor: "Exoskeletal ak ultra-light m".
How much does Medicare pay for L5790?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $880.26–$1,173.68. Rural fees can be higher.
Does Medicare cover L5790?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L5790 change in 2026?
The average non-rural state fee moved from $955.86 in 2025 to $974.98 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L5790 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)
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 L5790
- Watch L5790 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L5790
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.