Browse HCPCS Level II 2020 Edition

L5704 - L5707  Prosthetic Procedures - Lower Limb - Protective Covers

L5704 Custom shaped protective cover, below knee short Custom shape cover bk MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L5705 Custom shaped protective cover, above knee short Custom shape cover ak MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L5706 Custom shaped protective cover, knee disarticulation short Custom shape cvr knee disart MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L5707 Custom shaped protective cover, hip disarticulation short Custom shape cvr hip disart MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration