Coding: Browse HCPCS Level II 2020 Edition

Browse HCPCS Level II 2020 Edition

HCPCS Level II Table of Contents

L5968 - L5999 Prosthetic Procedures - Lower Limb - Additions to Ankle and/or Foot

L5968

Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature

short

Multiaxial ankle w dorsiflex

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

L5969

Addition, endoskeletal ankle-foot or ankle system, power assist, includes any type motor(s)

short

Ak/ft power asst incl motors

MUE

Location	Ajudication Indicator	Rationale
PRA	3 Date of Service Edit: Clinical	CMS Policy
OPH	3 Date of Service Edit: Clinical	CMS Policy
DME	3 Date of Service Edit: Clinical	Published Contractor Policy

L5970

All lower extremity prostheses, foot, external keel, sach foot

short

Foot external keel sach foot

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

L5971

All lower extremity prosthesis, solid ankle cushion heel (sach) foot, replacement only

short

Sach foot, replacement

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

L5972

All lower extremity prostheses, foot, flexible keel

short

Flexible keel foot

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

L5973

Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source

short

Ank-foot sys dors-plant flex

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	3 Date of Service Edit: Clinical	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L5974

All lower extremity prostheses, foot, single axis ankle/foot

short

Foot single axis ankle/foot

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

L5975

All lower extremity prosthesis, combination single axis ankle and flexible keel foot

short

Combo ankle/foot prosthesis

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

L5976

All lower extremity prostheses, energy storing foot (seattle carbon copy ii or equal)

short

Energy storing foot

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

L5978

All lower extremity prostheses, foot, multiaxial ankle/foot

short

Ft prosth multiaxial ankl/ft

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

L5979

All lower extremity prosthesis, multi-axial ankle, dynamic response foot, one piece system

short

Multi-axial ankle/ft prosth

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

L5980

All lower extremity prostheses, flex foot system

short

Flex foot system

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

L5981

All lower extremity prostheses, flex-walk system or equal

short

Flex-walk sys low ext prosth

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

L5982

All exoskeletal lower extremity prostheses, axial rotation unit

short

Exoskeletal axial rotation u

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

L5984

All endoskeletal lower extremity prosthesis, axial rotation unit, with or without adjustability

short

Endoskeletal axial rotation

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

L5985

All endoskeletal lower extremity prostheses, dynamic prosthetic pylon

short

Lwr ext dynamic prosth pylon

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

L5986

All lower extremity prostheses, multi-axial rotation unit ('mcp' or equal)

short

Multi-axial rotation unit

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

L5987

All lower extremity prosthesis, shank foot system with vertical loading pylon

short

Shank ft w vert load pylon

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

L5988

Addition to lower limb prosthesis, vertical shock reducing pylon feature

short

Vertical shock reducing pylo

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

L5990

Addition to lower extremity prosthesis, user adjustable heel height

short

User adjustable heel height

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

L5999

Lower extremity prosthesis, not otherwise specified

short

Lowr extremity prosthes nos

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	3 Date of Service Edit: Clinical	Clinical: CMS Workgroup