L5816 HCPCS code: Addition, endoskeletal knee-shin system, polycentric, mechanical stance phase lock
L5816 is the HCPCS Level II code for addition, endoskeletal knee-shin system, polycentric, mechanical stance phase lock. The 2026 Medicare DMEPOS fee schedule pays $618.67 to $2,023.41 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. In 2023, 10 suppliers billed Medicare for L5816 (purchases), serving 13 beneficiaries. Its average fee ranks 6 of 22 L58 codes (family range $167.80–$29,408.45).
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 L5816
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $618.67 | $2,023.41 | $1,388.21 | $1,041.16 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $1,892.29 | — |
| AL | — | $1,047.44 | — |
| AR | — | $1,186.56 | — |
| AZ | — | $1,388.21 | — |
| CA | — | $1,388.21 | — |
| CO | — | $1,388.21 | — |
| CT | — | $1,122.68 | — |
| DC | — | $1,041.16 | — |
| DE | — | $1,041.16 | — |
| FL | — | $1,047.44 | — |
| GA | — | $1,047.44 | — |
| HI | — | $2,023.41 | — |
| IA | — | $1,041.16 | — |
| ID | — | $1,041.16 | — |
| IL | — | $1,041.16 | — |
| IN | — | $1,041.16 | — |
| KS | — | $1,041.16 | — |
| KY | — | $1,047.44 | — |
| LA | — | $1,186.56 | — |
| MA | — | $1,122.68 | — |
| MD | — | $1,041.16 | — |
| ME | — | $1,122.68 | — |
| MI | — | $1,041.16 | — |
| MN | — | $1,041.16 | — |
| MO | — | $1,041.16 | — |
| MS | — | $1,047.44 | — |
| MT | — | $1,388.21 | — |
| NC | — | $1,047.44 | — |
| ND | — | $1,388.21 | — |
| NE | — | $1,041.16 | — |
| NH | — | $1,122.68 | — |
| NJ | — | $1,041.16 | — |
| NM | — | $1,186.56 | — |
| NV | — | $1,388.21 | — |
| NY | — | $1,041.16 | — |
| OH | — | $1,041.16 | — |
| OK | — | $1,186.56 | — |
| OR | — | $1,041.16 | — |
| PA | — | $1,041.16 | — |
| PR | — | $618.67 | — |
| RI | — | $1,122.68 | — |
| SC | — | $1,047.44 | — |
| SD | — | $1,388.21 | — |
| TN | — | $1,047.44 | — |
| TX | — | $1,186.56 | — |
| UT | — | $1,388.21 | — |
| VA | — | $1,041.16 | — |
| VI | — | $1,041.16 | — |
| VT | — | $1,122.68 | — |
| WA | — | $1,041.16 | — |
| WI | — | $1,041.16 | — |
| WV | — | $1,041.16 | — |
| WY | — | $1,388.21 | — |
How the L5816 fee compares
| Measure | Value |
|---|---|
| Rank among 22 L58 codes (lowest = 1) | 6 |
| Family fee range (average of state fees) | $167.80–$29,408.45 |
| Rural fee uplift | — |
Who bills L5816 (2023)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 10 |
| Referring clinicians | 13 |
| Medicare beneficiaries | 13 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L5816, 2023–2023
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2023 | 13 | 13 | $1,088.94 | $853.73 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 2 | Anatomic Consideration |
| outpatient hospital claims | 2 | Anatomic Consideration |
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 L5816
- 2026-01-01: Average state fee rose 2.0%: $1,128.04 to $1,150.61
- 1988-01-01: L5816 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 L5816?
L5816 is the HCPCS Level II code for addition, endoskeletal knee-shin system, polycentric, mechanical stance phase lock. Short descriptor: "Endo knee-shin polyc mch sta".
How much does Medicare pay for L5816?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $618.67–$2,023.41. Rural fees can be higher.
Does Medicare cover L5816?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L5816 change in 2026?
The average non-rural state fee moved from $1,128.04 in 2025 to $1,150.61 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L5816 can be billed per day?
2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).
Related L58 codes
- L5810 — Addition, endoskeletal knee-shin system, single axis, manual lock ($475.88–$1,129.31)
- L5811 — Addition, endoskeletal knee-shin system, single axis, manual lock, ultra-light material ($892.86–$1,651.67)
- L5812 — Addition, endoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee) ($692.06–$1,262.70)
- L5814 — Addition, endoskeletal knee-shin system, polycentric, hydraulic swing phase control, mechanical stance phase lock ($4,463.43–$4,909.82)
- L5818 — Addition, endoskeletal knee-shin system, polycentric, friction swing, and stance phase control ($1,175.67–$2,038.75)
- L5822 — Addition, endoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control ($1,427.66–$2,779.69)
- L5824 — Addition, endoskeletal knee-shin system, single axis, fluid swing phase control ($1,808.36–$3,524.23)
- L5826 — Addition, endoskeletal knee-shin system, single axis, hydraulic swing phase control, with miniature high activity frame ($3,753.23–$4,503.85)
- L5827 — Endoskeletal knee-shin system, single axis, electromechanical swing and stance phase control, with or without shock absorption and stance extension damping ($6,903.72–$8,403.35)
- L5828 — Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control ($3,457.19–$4,956.82)
- L5830 — Addition, endoskeletal knee-shin system, single axis, pneumatic/ swing phase control ($2,128.21–$4,205.51)
- L5840 — Addition, endoskeletal knee/shin system, 4-bar linkage or multiaxial, pneumatic swing phase control ($4,294.90–$5,293.48)
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 L5816
- Watch L5816 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L5816
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.