L5961 HCPCS code: Addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion and/or extension control
L5961 is the HCPCS Level II code for addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion and/or extension control. The 2026 Medicare DMEPOS fee schedule pays $5,299.60 to $6,659.78 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 1 per day on DME suppliers. Medicare volume fell 10% from 2022 to 2024 (29 to 26 services). In 2024, 24 suppliers billed Medicare for L5961 (purchases), serving 26 beneficiaries. Its average fee ranks 29 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 | 2011-01-01 |
| Last action effective | 2011-01-01 |
2026 Medicare DMEPOS fee schedule for L5961
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $5,299.60 | $6,659.78 | $6,985.53 | $5,239.15 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $6,258.17 | — |
| AL | — | $5,627.80 | — |
| AR | — | $5,837.22 | — |
| AZ | — | $6,280.50 | — |
| CA | — | $6,280.50 | — |
| CO | — | $6,277.25 | — |
| CT | — | $5,587.58 | — |
| DC | — | $5,569.67 | — |
| DE | — | $5,569.67 | — |
| FL | — | $5,627.80 | — |
| GA | — | $5,627.80 | — |
| HI | — | $6,659.78 | — |
| IA | — | $5,975.62 | — |
| ID | — | $5,939.38 | — |
| IL | — | $5,877.61 | — |
| IN | — | $5,877.61 | — |
| KS | — | $5,975.62 | — |
| KY | — | $5,627.80 | — |
| LA | — | $5,837.22 | — |
| MA | — | $5,587.58 | — |
| MD | — | $5,569.67 | — |
| ME | — | $5,587.58 | — |
| MI | — | $5,877.61 | — |
| MN | — | $5,877.61 | — |
| MO | — | $5,975.62 | — |
| MS | — | $5,627.80 | — |
| MT | — | $6,277.25 | — |
| NC | — | $5,627.80 | — |
| ND | — | $6,277.25 | — |
| NE | — | $5,975.62 | — |
| NH | — | $5,587.58 | — |
| NJ | — | $5,299.60 | — |
| NM | — | $5,837.22 | — |
| NV | — | $6,280.50 | — |
| NY | — | $5,299.60 | — |
| OH | — | $5,877.61 | — |
| OK | — | $5,837.22 | — |
| OR | — | $5,939.38 | — |
| PA | — | $5,569.67 | — |
| PR | — | $5,756.17 | — |
| RI | — | $5,587.58 | — |
| SC | — | $5,627.80 | — |
| SD | — | $6,277.25 | — |
| TN | — | $5,627.80 | — |
| TX | — | $5,837.22 | — |
| UT | — | $6,277.25 | — |
| VA | — | $5,569.67 | — |
| VI | — | $5,746.00 | — |
| VT | — | $5,587.58 | — |
| WA | — | $5,939.38 | — |
| WI | — | $5,877.61 | — |
| WV | — | $5,569.67 | — |
| WY | — | $6,277.25 | — |
How the L5961 fee compares
| Measure | Value |
|---|---|
| Rank among 32 L59 codes (lowest = 1) | 29 |
| Family fee range (average of state fees) | $280.68–$21,399.63 |
| Rural fee uplift | — |
Who bills L5961 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 24 |
| Referring clinicians | 25 |
| Medicare beneficiaries | 26 |
| States with claims | 0 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 29 | 29 |
| 2023 | 25 | 26 |
| 2024 | 24 | 26 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L5961, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 29 | 29 | $4,949.20 | $3,909.66 |
| 2023 | 26 | 26 | $5,379.84 | $4,078.13 |
| 2024 | 26 | 26 | $5,471.57 | $4,138.87 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1 | Nature of Equipment |
| outpatient hospital claims | 1 | 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 L5961
- 2026-01-01: Average state fee rose 2.0%: $5,728.13 to $5,842.69
- 2011-01-01: L5961 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 L5961?
L5961 is the HCPCS Level II code for addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion and/or extension control. Short descriptor: "Endo poly hip, pneu/hyd/rot".
How much does Medicare pay for L5961?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $5,299.60–$6,659.78. Rural fees can be higher.
Does Medicare cover L5961?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L5961 change in 2026?
The average non-rural state fee moved from $5,728.13 in 2025 to $5,842.69 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L5961 can be billed per day?
1 on DME suppliers; 1 on outpatient hospital claims (NCCI medically unlikely edits).
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)
- L5926 — Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type ($494.92–$1,173.77)
- 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)
- 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 L5961
- Watch L5961 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L5961
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.