DME MACs Update Policy Article for Recently-Created L Code
Recently, Medicare introduced a new L code, L5783, which became effective on April 1, 2024. In our March 27 post discussing the pending effective date for this code, we called out the fact that it was possible the DME MACs would provide additional guidance about it. They've now issued that guidance, and we'll walk you through it in this post.
What You Need to Know
The DME MACs updated the Lower Limb Prostheses Policy Article to provide more detailed guidance on the application and use of the newly established L5783:
- L5783 describes a complete mechanical product used as an addition to current lower extremity prosthetic base socket and socket replacement codes. This system is a kit of components (reel, cable, or similar) incorporated into a custom-fabricated socket. The beneficiary can manually adjust their socket volume throughout the day, decrease or increase. Code L5999 (LOWER EXTREMITY PROSTHESIS, NOT OTHERWISE SPECIFIED) must not be used to bill for any features or functions included in the socket or addition codes. Use of L5999 is incorrect coding (unbundling).
What this Means for You
The Policy Article aims to clarify what L5783 describes, specifying that to qualify for this code, the volume-adjustment system (1) must be a kit of components that (2) get incorporated - i.e., fabricated - into a custom-fabricated socket. It must also (3) permit patients to adjust socket volume - both increases and decreases in volume - throughout the time they wear their prosthesis. It also makes clear that (4) any use of L5999 in conjunction with such a system is considered unbundling.
Before billing for L5783, make sure that the device you are using satisfies each and every one of these four requirements. You can access the complete Lower Limb Prostheses Policy Article here.