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
shortMultiaxial ankle w dorsiflex
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L5969
Addition, endoskeletal ankle-foot or ankle system, power assist, includes any type motor(s)
shortAk/ft power asst incl motors
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME0.03 Date of Service Edit: ClinicalPublished Contractor Policy
L5970
All lower extremity prostheses, foot, external keel, sach foot
shortFoot external keel sach foot
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L5971
All lower extremity prosthesis, solid ankle cushion heel (sach) foot, replacement only
shortSach foot, replacement
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L5972
All lower extremity prostheses, foot, flexible keel
shortFlexible keel foot
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L5973
Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source
shortAnk-foot sys dors-plant flex
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.03 Date of Service Edit: ClinicalAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L5974
All lower extremity prostheses, foot, single axis ankle/foot
shortFoot single axis ankle/foot
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L5975
All lower extremity prosthesis, combination single axis ankle and flexible keel foot
shortCombo ankle/foot prosthesis
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L5976
All lower extremity prostheses, energy storing foot (seattle carbon copy ii or equal)
shortEnergy storing foot
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L5978
All lower extremity prostheses, foot, multiaxial ankle/foot
shortFt prosth multiaxial ankl/ft
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L5979
All lower extremity prosthesis, multi-axial ankle, dynamic response foot, one piece system
shortMulti-axial ankle/ft prosth
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L5980
All lower extremity prostheses, flex foot system
shortFlex foot system
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L5981
All lower extremity prostheses, flex-walk system or equal
shortFlex-walk sys low ext prosth
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L5982
All exoskeletal lower extremity prostheses, axial rotation unit
shortExoskeletal axial rotation u
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L5984
All endoskeletal lower extremity prosthesis, axial rotation unit, with or without adjustability
shortEndoskeletal axial rotation
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L5985
All endoskeletal lower extremity prostheses, dynamic prosthetic pylon
shortLwr ext dynamic prosth pylon
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L5986
All lower extremity prostheses, multi-axial rotation unit ('mcp' or equal)
shortMulti-axial rotation unit
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L5987
All lower extremity prosthesis, shank foot system with vertical loading pylon
shortShank ft w vert load pylon
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L5988
Addition to lower limb prosthesis, vertical shock reducing pylon feature
shortVertical shock reducing pylo
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L5990
Addition to lower extremity prosthesis, user adjustable heel height
shortUser adjustable heel height
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L5999
Lower extremity prosthesis, not otherwise specified
shortLowr extremity prosthes nos
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.03 Date of Service Edit: ClinicalClinical: CMS Workgroup