L5926 HCPCS code: Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type
L5926 is the HCPCS Level II code for addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type. The 2026 Medicare DMEPOS fee schedule pays $494.92 to $1,173.77 depending on the state. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. In 2024, 261 suppliers billed Medicare for L5926 (purchases), serving 471 beneficiaries; New York, Texas, Pennsylvania accounted for 39% of services. Its average fee ranks 14 of 32 L59 codes (family range $280.68–$21,399.63).
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 | 2024-01-01 |
| Last action effective | 2024-01-01 |
2026 Medicare DMEPOS fee schedule for L5926
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $494.92 | $1,173.77 | $929.89 | $697.41 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $1,097.66 | — |
| AL | — | $697.41 | — |
| AR | — | $823.06 | — |
| AZ | — | $929.89 | — |
| CA | — | $929.89 | — |
| CO | — | $738.45 | — |
| CT | — | $847.46 | — |
| DC | — | $701.46 | — |
| DE | — | $701.46 | — |
| FL | — | $697.41 | — |
| GA | — | $697.41 | — |
| HI | — | $1,173.77 | — |
| IA | — | $817.24 | — |
| ID | — | $884.40 | — |
| IL | — | $791.74 | — |
| IN | — | $791.74 | — |
| KS | — | $817.24 | — |
| KY | — | $697.41 | — |
| LA | — | $823.06 | — |
| MA | — | $847.46 | — |
| MD | — | $701.46 | — |
| ME | — | $847.46 | — |
| MI | — | $791.74 | — |
| MN | — | $791.74 | — |
| MO | — | $817.24 | — |
| MS | — | $697.41 | — |
| MT | — | $738.45 | — |
| NC | — | $697.41 | — |
| ND | — | $738.45 | — |
| NE | — | $817.24 | — |
| NH | — | $847.46 | — |
| NJ | — | $697.41 | — |
| NM | — | $823.06 | — |
| NV | — | $929.89 | — |
| NY | — | $697.41 | — |
| OH | — | $791.74 | — |
| OK | — | $823.06 | — |
| OR | — | $884.40 | — |
| PA | — | $701.46 | — |
| PR | — | $494.92 | — |
| RI | — | $847.46 | — |
| SC | — | $697.41 | — |
| SD | — | $738.45 | — |
| TN | — | $697.41 | — |
| TX | — | $823.06 | — |
| UT | — | $738.45 | — |
| VA | — | $701.46 | — |
| VI | — | $697.41 | — |
| VT | — | $847.46 | — |
| WA | — | $884.40 | — |
| WI | — | $791.74 | — |
| WV | — | $701.46 | — |
| WY | — | $738.45 | — |
How the L5926 fee compares
| Measure | Value |
|---|---|
| Rank among 32 L59 codes (lowest = 1) | 14 |
| Family fee range (average of state fees) | $280.68–$21,399.63 |
| Rural fee uplift | — |
Who bills L5926 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 261 |
| Referring clinicians | 353 |
| Medicare beneficiaries | 471 |
| States with claims | 15 |
| Share of services in top 3 states (New York, Texas, Pennsylvania) | 39% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L5926, 2024–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2024 | 493 | 471 | $737.41 | $570.29 |
States with the most L5926 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| New York | 53 | $512.22 |
| Texas | 51 | $589.76 |
| Pennsylvania | 31 | $517.11 |
| Florida | 26 | $522.48 |
| California | 23 | $691.74 |
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 L5926
- 2026-01-01: Average state fee rose 2.0%: $772.10 to $787.54
- 2024-01-01: L5926 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 L5926?
L5926 is the HCPCS Level II code for addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type. Short descriptor: "Endoskel posit rotat unit".
How much does Medicare pay for L5926?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $494.92–$1,173.77. Rural fees can be higher.
Does Medicare cover L5926?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L5926 change in 2026?
The average non-rural state fee moved from $772.10 in 2025 to $787.54 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
Related L59 codes
- L5910 — Addition, endoskeletal system, below knee, alignable system ($379.75–$856.60)
- L5920 — Addition, endoskeletal system, above knee or hip disarticulation, alignable system ($612.00–$1,713.20)
- L5925 — Addition, endoskeletal system, above knee, knee disarticulation or hip disarticulation, manual lock ($411.36–$742.65)
- L5930 — Addition, endoskeletal system, high activity knee control frame ($4,045.31–$4,449.83)
- L5940 — Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) ($614.10–$1,142.13)
- L5950 — Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal) ($939.43–$1,269.97)
- L5960 — Addition, endoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal) ($1,134.89–$2,331.87)
- L5961 — Addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion and/or extension control ($5,299.60–$6,659.78)
- L5962 — Addition, endoskeletal system, below knee, flexible protective outer surface covering system ($719.60–$959.46)
- L5964 — Addition, endoskeletal system, above knee, flexible protective outer surface covering system ($1,146.54–$1,408.24)
- L5966 — Addition, endoskeletal system, hip disarticulation, flexible protective outer surface covering system ($1,460.97–$1,825.66)
- L5968 — Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature ($4,367.40–$5,240.84)
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Next steps
- Run a reimbursement report for a device billed under L5926
- Watch L5926 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L5926
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.