L5999 HCPCS code: Lower extremity prosthesis, not otherwise specified
L5999 is the HCPCS Level II code for lower extremity prosthesis, not otherwise specified. In 2024 Medicare paid an average of $1,006.24 per service for L5999 across 427 services. 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 outpatient hospital claims. Medicare volume fell 20% from 2022 to 2024 (531 to 427 services). In 2024, 155 suppliers billed Medicare for L5999 (purchases), serving 257 beneficiaries; New York, Minnesota, Michigan accounted for 46% of services.
Code details
| Field | Value |
|---|---|
| Section | L codes — Orthotic and prosthetic procedures and devices |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 46 — Priced by the Medicare contractor (no national fee) |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 1982-01-01 |
| Last action effective | 1998-01-01 |
Who bills L5999 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 155 |
| Referring clinicians | 234 |
| Medicare beneficiaries | 257 |
| States with claims | 10 |
| Share of services in top 3 states (New York, Minnesota, Michigan) | 46% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 209 | 361 |
| 2023 | 194 | 290 |
| 2024 | 155 | 257 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L5999, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 531 | 361 | $933.42 | $734.76 |
| 2023 | 440 | 290 | $1,599.88 | $1,239.02 |
| 2024 | 427 | 257 | $1,285.93 | $1,006.24 |
States with the most L5999 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| New York | 49 | $1,853.78 |
| Minnesota | 34 | $1,156.44 |
| Michigan | 33 | $287.85 |
| Pennsylvania | 31 | $283.20 |
| Texas | 24 | $739.35 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 2 | Clinical: CMS Workgroup |
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
- A52501: Therapeutic Shoes for Persons with Diabetes - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (428 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| E08.00 | Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) | 1 |
| E08.01 | Diabetes mellitus due to underlying condition with hyperosmolarity with coma | 1 |
| E08.10 | Diabetes mellitus due to underlying condition with ketoacidosis without coma | 1 |
| E08.11 | Diabetes mellitus due to underlying condition with ketoacidosis with coma | 1 |
| E08.21 | Diabetes mellitus due to underlying condition with diabetic nephropathy | 1 |
| E08.22 | Diabetes mellitus due to underlying condition with diabetic chronic kidney disease | 1 |
| E08.29 | Diabetes mellitus due to underlying condition with other diabetic kidney complication | 1 |
| E08.311 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema | 1 |
| E08.319 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema | 1 |
| E08.3211 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye | 1 |
Showing 10 of 428. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for L5999
- 1982-01-01: L5999 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 L5999?
L5999 is the HCPCS Level II code for lower extremity prosthesis, not otherwise specified. Short descriptor: "Lowr extremity prosthes nos".
How much does Medicare pay for L5999?
In 2024, the average Medicare payment was $1,006.24 per service (average allowed $1,285.93).
Does Medicare cover L5999?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for L5999?
Medicare policy articles that cite L5999 list 428 covered ICD-10-CM diagnosis codes across 2 articles. The most cited include E08.00 (Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)), E08.01 (Diabetes mellitus due to underlying condition with hyperosmolarity with coma), E08.10 (Diabetes mellitus due to underlying condition with ketoacidosis without coma). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of L5999 can be billed per day?
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 L5999
- Watch L5999 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L5999
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; 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.