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Current CMS pricing and breakdown for ~ADDITION ENDOSKLETL KNEE-SHI.
| Quarter | Q2 2025 | Q3 2025 | Q4 2025 | Q1 2026 | Q2 2026 | Q3 2026 |
|---|---|---|---|---|---|---|
| National Average Payment | $3,159.13 | $3,159.13 | $3,159.13 | $3,222.30 | $3,222.30 | $3,222.30 |
Your actual reimbursement depends on your specific Zip Code and GPCI adjustments (e.g., New York vs. Texas).
Addition, endoskeletal knee-shin system, polycentric, pneumatic swing, and stance phase control
CPT code L5841 (Addition, endoskeletal knee-shin system, polycentric, pneumatic swing, and stance phase control) had a 2026 Medicare non-facility reimbursement rate of $3,222.30. This reflects a 2.00% change from the prior year.
The 2026 National Medicare reimbursement estimate for L5841 is $3,222.30. Actual payment can vary by locality, setting, and claim specifics.
Description: Addition, endoskeletal knee-shin system, polycentric, pneumatic swing, and stance phase control. For locality-adjusted estimates, use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool.
| Quarter | Q2 2025 | Q3 2025 | Q4 2025 | Q1 2026 | Q2 2026 | Q3 2026 |
|---|---|---|---|---|---|---|
| National Average Payment | $3,159.13 | $3,159.13 | $3,159.13 | $3,222.30 | $3,222.30 | $3,222.30 |
| Quarter | Non-Facility Rate | Facility Rate | YoY % Change (Non-Fac) | YoY % Change (Fac) |
|---|---|---|---|---|
| 2026 Q3 | $3,222.30 | $3,222.30 | +2.00% | +2.00% |
| 2026 Q2 | $3,222.30 | $3,222.30 | +2.00% | +2.00% |
| 2026 Q1 | $3,222.30 | $3,222.30 | +2.00% | +2.00% |
| 2025 Q4 | $3,159.13 | $3,159.13 | — | — |
| 2025 Q3 | $3,159.13 | $3,159.13 | — | — |
| 2025 Q2 | $3,159.13 | $3,159.13 | — | — |
| 2025 Q1 | $3,159.13 | $3,159.13 | — | — |
| Component | Office (Non-Fac) | Facility (Hosp) |
|---|---|---|
| Work RVU | ||
| Practice Expense (PE) | ||
| Malpractice (MP) | ||
| Total RVUs | 0.00 | 0.00 |
Compare a payment against the Medicare benchmark for this code.
Medicare rates are used as a benchmark only. Actual payer contracts, modifiers, place of service, units, and billing rules may affect reimbursement. This tool is for educational and operational review purposes, not legal or billing advice.
National average reimbursement from major commercial payers based on CMS Transparency in Coverage machine-readable files.
| Modifier | Place of Service | Avg. Rate | vs Medicare | Percentile Range |
|---|---|---|---|---|
| NULL | Office (11) | $91.46 | -4.0% | $80 — $104 |
| NULL | Telehealth (02) | $88.20 | -7.4% | $76 — $102 |
| NULL | Facility (21) | $79.31 | -15.6% | $68 — $95 |
| NULL | Outpatient Hospital (22) | $84.92 | -10.2% | $71 — $99 |
| NULL | Home (12) | $96.14 | +1.0% | $84 — $113 |
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Source: CMS Transparency in Coverage machine-readable files (MRFs). Commercial rates reflect payer-published negotiated amounts and may not reflect individual contracted rates.
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Facility vs. non-facility pricing most commonly applies to physician services paid under the RVU-based Physician Fee Schedule. For L5841 (DMEPOS Equipment), the payment methodology may not include both facility and non-facility rates.
Medicare reimbursement is determined by RVUs, geographic adjustments, and the annual conversion factor.
The 2026 National Average Medicare reimbursement rate for L5841 (DMEPOS Equipment) is $3,222.30. This rate is effective as of January 1, 2026.
Addition, endoskeletal knee-shin system, polycentric, pneumatic swing, and stance phase control
Facility vs. non-facility differences usually apply to RVU-based physician services. L5841 may not use both facility and non-facility pricing depending on its payment methodology.
Use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool on the homepage to estimate your locality-adjusted reimbursement. Medicare payment can vary based on geographic adjustments (GPCI), place of service, and claim specifics.
Coverage depends on medical necessity, setting, and Medicare policy. Some codes may be bundled, contractor-priced, or restricted. Verify final coverage guidance through CMS or your local MAC when applicable.