L5972 HCPCS code: All lower extremity prostheses, foot, flexible keel
L5972 is the HCPCS Level II code for all lower extremity prostheses, foot, flexible keel. The 2026 Medicare DMEPOS fee schedule pays $333.11 to $733.99 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 fell 8% from 2022 to 2024 (9,687 to 8,873 services). In 2024, 1,844 suppliers billed Medicare for L5972 (purchases), serving 7,934 beneficiaries; Texas, California, Florida accounted for 28% of services. Its average fee ranks 6 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 | 1989-01-01 |
| Last action effective | 2013-01-01 |
2026 Medicare DMEPOS fee schedule for L5972
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $333.11 | $733.99 | $575.28 | $431.46 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $686.35 | — |
| AL | — | $464.44 | — |
| AR | — | $524.57 | — |
| AZ | — | $575.28 | — |
| CA | — | $575.28 | — |
| CO | — | $538.97 | — |
| CT | — | $502.95 | — |
| DC | — | $431.46 | — |
| DE | — | $431.46 | — |
| FL | — | $464.44 | — |
| GA | — | $464.44 | — |
| HI | — | $733.99 | — |
| IA | — | $477.56 | — |
| ID | — | $479.92 | — |
| IL | — | $487.23 | — |
| IN | — | $487.23 | — |
| KS | — | $477.56 | — |
| KY | — | $464.44 | — |
| LA | — | $524.57 | — |
| MA | — | $502.95 | — |
| MD | — | $431.46 | — |
| ME | — | $502.95 | — |
| MI | — | $487.23 | — |
| MN | — | $487.23 | — |
| MO | — | $477.56 | — |
| MS | — | $464.44 | — |
| MT | — | $538.97 | — |
| NC | — | $464.44 | — |
| ND | — | $538.97 | — |
| NE | — | $477.56 | — |
| NH | — | $502.95 | — |
| NJ | — | $431.46 | — |
| NM | — | $524.57 | — |
| NV | — | $575.28 | — |
| NY | — | $431.46 | — |
| OH | — | $487.23 | — |
| OK | — | $524.57 | — |
| OR | — | $479.92 | — |
| PA | — | $431.46 | — |
| PR | — | $333.11 | — |
| RI | — | $502.95 | — |
| SC | — | $464.44 | — |
| SD | — | $538.97 | — |
| TN | — | $464.44 | — |
| TX | — | $524.57 | — |
| UT | — | $538.97 | — |
| VA | — | $431.46 | — |
| VI | — | $431.46 | — |
| VT | — | $502.95 | — |
| WA | — | $479.92 | — |
| WI | — | $487.23 | — |
| WV | — | $431.46 | — |
| WY | — | $538.97 | — |
How the L5972 fee compares
| Measure | Value |
|---|---|
| Rank among 32 L59 codes (lowest = 1) | 6 |
| Family fee range (average of state fees) | $280.68–$21,399.63 |
| Rural fee uplift | — |
Who bills L5972 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 1,844 |
| Referring clinicians | 5,541 |
| Medicare beneficiaries | 7,934 |
| States with claims | 50 |
| Share of services in top 3 states (Texas, California, Florida) | 28% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 1,958 | 8,739 |
| 2023 | 1,911 | 8,457 |
| 2024 | 1,844 | 7,934 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L5972, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 9,687 | 8,739 | $418.18 | $327.90 |
| 2023 | 9,459 | 8,457 | $454.53 | $354.08 |
| 2024 | 8,873 | 7,934 | $466.60 | $363.25 |
States with the most L5972 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 944 | $388.13 |
| California | 885 | $421.85 |
| Florida | 660 | $346.84 |
| New York | 506 | $322.63 |
| Pennsylvania | 417 | $321.51 |
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 L5972
- 2026-01-01: Average state fee rose 2.0%: $485.12 to $494.82
- 1989-01-01: L5972 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 L5972?
L5972 is the HCPCS Level II code for all lower extremity prostheses, foot, flexible keel. Short descriptor: "Flexible keel foot".
How much does Medicare pay for L5972?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $333.11–$733.99. Rural fees can be higher.
Does Medicare cover L5972?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L5972 change in 2026?
The average non-rural state fee moved from $485.12 in 2025 to $494.82 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L5972 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)
- 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)
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 L5972
- Watch L5972 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L5972
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.