L5696 — Addition to lower extremity, above knee or knee disarticulation, pelvic joint
L5696 is a HCPCS Level II code for addition to lower extremity, above knee or knee disarticulation, pelvic joint. It belongs to the Orthotic and Prosthetic Procedures and Devices section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Medically Unlikely Edits — units per day
The most units of L5696 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
- outpatient
- 2 units MAI 2 — Date of Service Edit: Policy · Anatomic Consideration
- DME supplier
- 2 units MAI 2 — Date of Service Edit: Policy · Anatomic Consideration
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for L5696
- Long descriptor
- Addition to lower extremity, above knee or knee disarticulation, pelvic joint
- Short descriptor
- Ak/knee disartic pelvic join
- Added
- January 1, 1986
- BETOS
- D1F
- Pricing indicator
- 38 — DMEPOS
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Orthotics, prosthetics, prosthetic devices and vision services. Price subject to floors and ceilings.
Codes adjacent to L5696
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If L5696 is not quite right, the correct code is very often within a few positions of it.
- L5684Addition to lower extremity, below knee, fork strap
- L5685Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each
- L5686Addition to lower extremity, below knee, back check (extension control)
- L5688Addition to lower extremity, below knee, waist belt, webbing
- L5690Addition to lower extremity, below knee, waist belt, padded and lined
- L5692Addition to lower extremity, above knee, pelvic control belt, light
- L5694Addition to lower extremity, above knee, pelvic control belt, padded and lined
- L5695Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each
- L5697Addition to lower extremity, above knee or knee disarticulation, pelvic band
- L5698Addition to lower extremity, above knee or knee disarticulation, silesian bandage
- L5699All lower extremity prostheses, shoulder harness
- L5700Replacement, socket, below knee, molded to patient model
- L5701Replacement, socket, above knee/knee disarticulation, including attachment plate, molded to patient model
- L5702Replacement, socket, hip disarticulation, including hip joint, molded to patient model
- L5703Ankle, symes, molded to patient model, socket without solid ankle cushion heel (sach) foot, replacement only
- L5704Custom shaped protective cover, below knee
Questions about L5696
What is HCPCS code L5696?
L5696 is a HCPCS Level II code for addition to lower extremity, above knee or knee disarticulation, pelvic joint. It sits in the Orthotic and Prosthetic Procedures and Devices section.
Does Medicare cover L5696?
The CMS HCPCS file marks L5696 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.