L5964 — Addition, endoskeletal system, above knee, flexible protective outer surface covering system
L5964 is a HCPCS Level II code for addition, endoskeletal system, above knee, flexible protective outer surface covering system. 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 L5964 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 L5964
- Long descriptor
- Addition, endoskeletal system, above knee, flexible protective outer surface covering system
- Short descriptor
- Above knee flex cover system
- Added
- January 1, 1994
- 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 L5964
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If L5964 is not quite right, the correct code is very often within a few positions of it.
- L5925Addition, endoskeletal system, above knee, knee disarticulation or hip disarticulation, manual lock
- L5926Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type
- L5930Addition, endoskeletal system, high activity knee control frame
- L5940Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)
- L5950Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)
- L5960Addition, endoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)
- L5961Addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion and/or extension control
- L5962Addition, endoskeletal system, below knee, flexible protective outer surface covering system
- L5966Addition, endoskeletal system, hip disarticulation, flexible protective outer surface covering system
- L5968Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature
- L5969Addition, endoskeletal ankle-foot or ankle system, power assist, includes any type motor(s)
- L5970All lower extremity prostheses, foot, external keel, sach foot
- L5971All lower extremity prosthesis, solid ankle cushion heel (sach) foot, replacement only
- L5972All lower extremity prostheses, foot, flexible keel
- L5973Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source
- L5974All lower extremity prostheses, foot, single axis ankle/foot
Questions about L5964
What is HCPCS code L5964?
L5964 is a HCPCS Level II code for addition, endoskeletal system, above knee, flexible protective outer surface covering system. It sits in the Orthotic and Prosthetic Procedures and Devices section.
Does Medicare cover L5964?
The CMS HCPCS file marks L5964 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.