L5962 HCPCS code: Addition, endoskeletal system, below knee, flexible protective outer surface covering system
L5962 is the HCPCS Level II code for addition, endoskeletal system, below knee, flexible protective outer surface covering system. The 2026 Medicare DMEPOS fee schedule pays $719.60 to $959.46 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 15 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 | 1994-01-01 |
| Last action effective | 1994-01-01 |
2026 Medicare DMEPOS fee schedule for L5962
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $719.60 | $959.46 | $959.46 | $719.60 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $890.66 | — |
| AL | — | $776.72 | — |
| AR | — | $776.67 | — |
| AZ | — | $959.46 | — |
| CA | — | $959.46 | — |
| CO | — | $916.71 | — |
| CT | — | $719.60 | — |
| DC | — | $719.60 | — |
| DE | — | $719.60 | — |
| FL | — | $776.72 | — |
| GA | — | $776.72 | — |
| HI | — | $890.66 | — |
| IA | — | $959.46 | — |
| ID | — | $959.46 | — |
| IL | — | $719.60 | — |
| IN | — | $719.60 | — |
| KS | — | $959.46 | — |
| KY | — | $776.72 | — |
| LA | — | $776.67 | — |
| MA | — | $719.60 | — |
| MD | — | $719.60 | — |
| ME | — | $719.60 | — |
| MI | — | $719.60 | — |
| MN | — | $719.60 | — |
| MO | — | $959.46 | — |
| MS | — | $776.72 | — |
| MT | — | $916.71 | — |
| NC | — | $776.72 | — |
| ND | — | $916.71 | — |
| NE | — | $959.46 | — |
| NH | — | $719.60 | — |
| NJ | — | $719.60 | — |
| NM | — | $776.67 | — |
| NV | — | $959.46 | — |
| NY | — | $719.60 | — |
| OH | — | $719.60 | — |
| OK | — | $776.67 | — |
| OR | — | $959.46 | — |
| PA | — | $719.60 | — |
| PR | — | $957.17 | — |
| RI | — | $719.60 | — |
| SC | — | $776.72 | — |
| SD | — | $916.71 | — |
| TN | — | $776.72 | — |
| TX | — | $776.67 | — |
| UT | — | $916.71 | — |
| VA | — | $719.60 | — |
| VI | — | $719.60 | — |
| VT | — | $719.60 | — |
| WA | — | $959.46 | — |
| WI | — | $719.60 | — |
| WV | — | $719.60 | — |
| WY | — | $916.71 | — |
How the L5962 fee compares
| Measure | Value |
|---|---|
| Rank among 32 L59 codes (lowest = 1) | 15 |
| Family fee range (average of state fees) | $280.68–$21,399.63 |
| 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 |
What changed for L5962
- 2026-01-01: Average state fee rose 2.0%: $796.19 to $812.11
- 1994-01-01: L5962 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 L5962?
L5962 is the HCPCS Level II code for addition, endoskeletal system, below knee, flexible protective outer surface covering system. Short descriptor: "Below knee flex cover system".
How much does Medicare pay for L5962?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $719.60–$959.46. Rural fees can be higher.
Does Medicare cover L5962?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L5962 change in 2026?
The average non-rural state fee moved from $796.19 in 2025 to $812.11 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L5962 can be billed per day?
2 on DME suppliers; 2 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)
- 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)
- 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 L5962
- Watch L5962 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L5962
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.