L5859 HCPCS code: Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s)
L5859 is the HCPCS Level II code for addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s). The 2026 Medicare DMEPOS fee schedule pays $17,437.90 to $19,181.69 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 28% from 2022 to 2024 (120 to 154 services). In 2024, 94 suppliers billed Medicare for L5859 (purchases), serving 133 beneficiaries. Its average fee ranks 20 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 | 2013-01-01 |
| Last action effective | 2013-01-01 |
2026 Medicare DMEPOS fee schedule for L5859
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $17,437.90 | $19,181.69 | $21,356.93 | $16,017.70 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $17,437.90 | — |
| AL | — | $17,962.99 | — |
| AR | — | $17,961.29 | — |
| AZ | — | $17,437.90 | — |
| CA | — | $17,437.90 | — |
| CO | — | $18,062.02 | — |
| CT | — | $17,437.90 | — |
| DC | — | $17,437.90 | — |
| DE | — | $17,437.90 | — |
| FL | — | $17,962.99 | — |
| GA | — | $17,962.99 | — |
| HI | — | $17,437.90 | — |
| IA | — | $17,778.41 | — |
| ID | — | $18,479.11 | — |
| IL | — | $17,866.14 | — |
| IN | — | $17,866.14 | — |
| KS | — | $17,778.41 | — |
| KY | — | $17,962.99 | — |
| LA | — | $17,961.29 | — |
| MA | — | $17,437.90 | — |
| MD | — | $17,437.90 | — |
| ME | — | $17,437.90 | — |
| MI | — | $17,866.14 | — |
| MN | — | $17,866.14 | — |
| MO | — | $17,778.41 | — |
| MS | — | $17,962.99 | — |
| MT | — | $18,062.02 | — |
| NC | — | $17,962.99 | — |
| ND | — | $18,062.02 | — |
| NE | — | $17,778.41 | — |
| NH | — | $17,437.90 | — |
| NJ | — | $17,437.90 | — |
| NM | — | $17,961.29 | — |
| NV | — | $17,437.90 | — |
| NY | — | $17,437.90 | — |
| OH | — | $17,866.14 | — |
| OK | — | $17,961.29 | — |
| OR | — | $18,479.11 | — |
| PA | — | $17,437.90 | — |
| PR | — | $19,181.69 | — |
| RI | — | $17,437.90 | — |
| SC | — | $17,962.99 | — |
| SD | — | $18,062.02 | — |
| TN | — | $17,962.99 | — |
| TX | — | $17,961.29 | — |
| UT | — | $18,062.02 | — |
| VA | — | $17,437.90 | — |
| VI | — | $19,181.69 | — |
| VT | — | $17,437.90 | — |
| WA | — | $18,479.11 | — |
| WI | — | $17,866.14 | — |
| WV | — | $17,437.90 | — |
| WY | — | $18,062.02 | — |
How the L5859 fee compares
| Measure | Value |
|---|---|
| Rank among 22 L58 codes (lowest = 1) | 20 |
| Family fee range (average of state fees) | $167.80–$29,408.45 |
| Rural fee uplift | — |
Who bills L5859 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 94 |
| Referring clinicians | 123 |
| Medicare beneficiaries | 133 |
| States with claims | 3 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 81 | 105 |
| 2023 | 116 | 161 |
| 2024 | 94 | 133 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L5859, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 120 | 105 | $15,193.51 | $11,856.16 |
| 2023 | 187 | 161 | $16,522.26 | $12,834.47 |
| 2024 | 154 | 133 | $16,865.64 | $13,108.72 |
States with the most L5859 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 25 | $13,483.25 |
| New York | 17 | $13,092.78 |
| New Jersey | 13 | $13,089.11 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 2 | Nature of Equipment |
| outpatient hospital claims | 2 | Nature of Equipment |
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 L5859
- 2026-01-01: Average state fee rose 2.0%: $17,486.38 to $17,836.11
- 2013-01-01: L5859 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 L5859?
L5859 is the HCPCS Level II code for addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s). Short descriptor: "Knee-shin pro flex/ext cont".
How much does Medicare pay for L5859?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $17,437.90–$19,181.69. Rural fees can be higher.
Does Medicare cover L5859?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L5859 change in 2026?
The average non-rural state fee moved from $17,486.38 in 2025 to $17,836.11 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L5859 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)
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 L5859
- Watch L5859 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L5859
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.