L5250 — Hip disarticulation, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot
L5250 is a HCPCS Level II code for hip disarticulation, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot. 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 L5250 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 L5250
- Long descriptor
- Hip disarticulation, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot
- Short descriptor
- Hip canad sing axi cons fric
- Added
- January 1, 1982
- 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 L5250
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If L5250 is not quite right, the correct code is very often within a few positions of it.
- L5100Below knee, molded socket, shin, sach foot
- L5105Below knee, plastic socket, joints and thigh lacer, sach foot
- L5150Knee disarticulation (or through knee), molded socket, external knee joints, shin, sach foot
- L5160Knee disarticulation (or through knee), molded socket, bent knee configuration, external knee joints, shin, sach foot
- L5200Above knee, molded socket, single axis constant friction knee, shin, sach foot
- L5210Above knee, short prosthesis, no knee joint ('stubbies'), with foot blocks, no ankle joints, each
- L5220Above knee, short prosthesis, no knee joint ('stubbies'), with articulated ankle/foot, dynamically aligned, each
- L5230Above knee, for proximal femoral focal deficiency, constant friction knee, shin, sach foot
- L5270Hip disarticulation, tilt table type; molded socket, locking hip joint, single axis constant friction knee, shin, sach foot
- L5280Hemipelvectomy, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot
- L5301Below knee, molded socket, shin, sach foot, endoskeletal system
- L5312Knee disarticulation (or through knee), molded socket, single axis knee, pylon, sach foot, endoskeletal system
- L5321Above knee, molded socket, open end, sach foot, endoskeletal system, single axis knee
- L5331Hip disarticulation, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot
- L5341Hemipelvectomy, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot
- L5400Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment, suspension, and one cast change, below knee
Questions about L5250
What is HCPCS code L5250?
L5250 is a HCPCS Level II code for hip disarticulation, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot. It sits in the Orthotic and Prosthetic Procedures and Devices section.
Does Medicare cover L5250?
The CMS HCPCS file marks L5250 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.