S98.131A: Complete traumatic amputation of one right lesser toe, initial encounter

S98.131A, complete traumatic amputation of one right lesser toe, initial encounter, is listed as a covered diagnosis in 5 Medicare billing and coding articles that apply to 180 HCPCS Level II codes, including L5280 (Hemipelvectomy, canadian type; molded socket, hip joint…), L5341 (Hemipelvectomy, canadian type, molded socket, endoskeletal…), L5250 (Hip disarticulation, canadian type; molded socket, hip…). 111 of these codes have a 2026 DMEPOS fee schedule amount; L5280 pays $6,233.46 to $12,932.84 depending on the state. The articles come from 3 Medicare contractors. A listed diagnosis supports medical necessity only; coverage still depends on the LCD's criteria and on documentation in the medical record.

HCPCS Level II codes with S98.131A as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
L5280Hemipelvectomy, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach footCarrier judgment$6,233.46–$12,932.841
L5341Hemipelvectomy, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach footCarrier judgment$6,039.09–$12,930.771
L5250Hip disarticulation, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach footCarrier judgment$6,352.07–$12,373.021
L5270Hip disarticulation, tilt table type; molded socket, locking hip joint, single axis constant friction knee, shin, sach footCarrier judgment$4,875.36–$11,580.411
L5595Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, thermoplastic or equal, molded to patient modelCarrier judgment$4,929.43–$11,195.961
L5600Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, laminated socket, molded to patient modelCarrier judgment$5,443.57–$10,073.551
L5331Hip disarticulation, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach footCarrier judgment$4,859.45–$7,517.951
L5160Knee disarticulation (or through knee), molded socket, bent knee configuration, external knee joints, shin, sach footCarrier judgment$4,676.12–$7,476.321
L5230Above knee, for proximal femoral focal deficiency, constant friction knee, shin, sach footCarrier judgment$4,657.24–$7,081.061
L5105Below knee, plastic socket, joints and thigh lacer, sach footCarrier judgment$4,252.97–$6,738.281
L5321Above knee, molded socket, open end, sach foot, endoskeletal system, single axis kneeCarrier judgment$4,023.73–$6,709.861
L5150Knee disarticulation (or through knee), molded socket, external knee joints, shin, sach footCarrier judgment$4,299.18–$6,662.401
L5200Above knee, molded socket, single axis constant friction knee, shin, sach footCarrier judgment$4,044.27–$5,901.011
L5220Above knee, short prosthesis, no knee joint ('stubbies'), with articulated ankle/foot, dynamically aligned, eachCarrier judgment$3,376.78–$5,593.501
L5210Above knee, short prosthesis, no knee joint ('stubbies'), with foot blocks, no ankle joints, eachCarrier judgment$2,970.73–$5,520.311
L2005Knee ankle foot orthosis, any material, single or double upright, stance control, automatic lock and swing phase release, any type activation, includes ankle joint, any type, custom fabricatedCarrier judgment$4,915.21–$5,406.751
L5312Knee disarticulation (or through knee), molded socket, single axis knee, pylon, sach foot, endoskeletal systemCarrier judgment$3,936.65–$5,384.231
L5060Ankle, symes, metal frame, molded leather socket, articulated ankle/footCarrier judgment$1,022.60–$4,748.301
L5590Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon no cover, sach foot, laminated socket, molded to modelCarrier judgment$2,943.01–$4,568.531
L5585Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, prefabricated adjustable open end socketCarrier judgment$3,132.31–$4,568.531
L5560Preparatory, above knee- knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to modelCarrier judgment$2,379.43–$4,568.531
L5301Below knee, molded socket, shin, sach foot, endoskeletal systemCarrier judgment$2,810.90–$4,330.821
L5580Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to modelCarrier judgment$1,738.32–$4,142.561
L5505Initial, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formedCarrier judgment$2,129.35–$3,997.431
L5050Ankle, symes, molded socket, sach footCarrier judgment$2,809.59–$3,807.081

155 more codes are listed. See every code with payment by region in Caduvo.

Medicare policy articles listing S98.131A

A diagnosis listed as covered in a billing and coding article supports medical necessity for the article's codes; it does not guarantee payment. Coverage depends on the LCD's criteria, the contractor's jurisdiction and documentation in the medical record.

Other S98 diagnoses (Traumatic amputation of ankle and foot)

Frequently asked questions

Does Medicare cover S98.131A (Complete traumatic amputation of one right lesser toe…)?

Medicare covers items and services, not diagnoses. 5 Medicare billing and coding articles list S98.131A as a covered diagnosis for 180 HCPCS Level II codes: the diagnosis can support medical necessity for those codes, but payment still depends on the LCD's coverage criteria and the medical record.

Which HCPCS codes can be billed with ICD-10 S98.131A?

The Level II codes from the policies most specific to this diagnosis are L5280 (Hemipelvectomy, canadian type; molded socket, hip joint…, 1 article); L5341 (Hemipelvectomy, canadian type, molded socket, endoskeletal…, 1 article); L5250 (Hip disarticulation, canadian type; molded socket, hip…, 1 article); L5270 (Hip disarticulation, tilt table type; molded socket…, 1 article); L5595 (Preparatory, hip disarticulation-hemipelvectomy, pylon, no…, 1 article). Code choice depends on the item supplied; check each code's descriptor.

What does Medicare pay for equipment billed with S98.131A?

Under the 2026 DMEPOS fee schedule (non-rural state fees): L5280 $6,233.46 to $12,932.84; L5341 $6,039.09 to $12,930.77; L5250 $6,352.07 to $12,373.02; L5270 $4,875.36 to $11,580.41. Medicare pays 80% of the allowed amount after the Part B deductible.

Which Medicare policy articles list S98.131A?

A52481 (Orthopedic Footwear - Policy Article); A57554 (Billing and Coding: Immune Globulins); A52438 (Billing and Coding: Tetanus Immunization), and 2 more articles.

What is ICD-10-CM code S98.131A?

S98.131A is the ICD-10-CM code for complete traumatic amputation of one right lesser toe, initial encounter, in category S98 (Traumatic amputation of ankle and foot), chapter 19: Injury, poisoning and other consequences of external causes.

Next steps

Sources: CMS Medicare Coverage Database billing and coding articles (covered ICD-10 code lists and HCPCS links); ICD-10-CM FY2026; CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026 (non-rural state fees). Not billing or legal advice.

Chapter 19: Injury, poisoning and other consequences of external causes · All diagnoses · HCPCS lookup