L5857 HCPCS code: Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type
L5857 is the HCPCS Level II code for addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type. The 2026 Medicare DMEPOS fee schedule pays $10,237.55 to $11,261.23 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 19 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 | 2005-01-01 |
| Last action effective | 2005-01-01 |
2026 Medicare DMEPOS fee schedule for L5857
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $10,237.55 | $11,261.23 | $12,544.36 | $9,408.27 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $10,302.64 | — |
| AL | — | $10,545.73 | — |
| AR | — | $10,544.80 | — |
| AZ | — | $10,237.55 | — |
| CA | — | $10,237.55 | — |
| CO | — | $10,582.89 | — |
| CT | — | $10,566.30 | — |
| DC | — | $10,237.55 | — |
| DE | — | $10,237.55 | — |
| FL | — | $10,545.73 | — |
| GA | — | $10,545.73 | — |
| HI | — | $10,758.68 | — |
| IA | — | $10,430.64 | — |
| ID | — | $10,237.55 | — |
| IL | — | $10,488.92 | — |
| IN | — | $10,488.92 | — |
| KS | — | $10,430.64 | — |
| KY | — | $10,545.73 | — |
| LA | — | $10,544.80 | — |
| MA | — | $10,566.30 | — |
| MD | — | $10,237.55 | — |
| ME | — | $10,566.30 | — |
| MI | — | $10,488.92 | — |
| MN | — | $10,488.92 | — |
| MO | — | $10,430.64 | — |
| MS | — | $10,545.73 | — |
| MT | — | $10,582.89 | — |
| NC | — | $10,545.73 | — |
| ND | — | $10,582.89 | — |
| NE | — | $10,430.64 | — |
| NH | — | $10,566.30 | — |
| NJ | — | $10,368.27 | — |
| NM | — | $10,544.80 | — |
| NV | — | $10,237.55 | — |
| NY | — | $10,368.27 | — |
| OH | — | $10,488.92 | — |
| OK | — | $10,544.80 | — |
| OR | — | $10,237.55 | — |
| PA | — | $10,237.55 | — |
| PR | — | $11,261.23 | — |
| RI | — | $10,566.30 | — |
| SC | — | $10,545.73 | — |
| SD | — | $10,582.89 | — |
| TN | — | $10,545.73 | — |
| TX | — | $10,544.80 | — |
| UT | — | $10,582.89 | — |
| VA | — | $10,237.55 | — |
| VI | — | $10,237.55 | — |
| VT | — | $10,566.30 | — |
| WA | — | $10,237.55 | — |
| WI | — | $10,488.92 | — |
| WV | — | $10,237.55 | — |
| WY | — | $10,582.89 | — |
How the L5857 fee compares
| Measure | Value |
|---|---|
| Rank among 22 L58 codes (lowest = 1) | 19 |
| Family fee range (average of state fees) | $167.80–$29,408.45 |
| 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 |
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 L5857
- 2026-01-01: Average state fee rose 2.0%: $10,262.45 to $10,467.70
- 2005-01-01: L5857 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 L5857?
L5857 is the HCPCS Level II code for addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type. Short descriptor: "Elec knee-shin swing only".
How much does Medicare pay for L5857?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $10,237.55–$11,261.23. Rural fees can be higher.
Does Medicare cover L5857?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L5857 change in 2026?
The average non-rural state fee moved from $10,262.45 in 2025 to $10,467.70 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L5857 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)
- L5816 — Addition, endoskeletal knee-shin system, polycentric, mechanical stance phase lock ($618.67–$2,023.41)
- 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)
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Next steps
- Run a reimbursement report for a device billed under L5857
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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.