New Prosthetic L-Code Goes Live on April 1st

What You Need to Know

Beginning on April 1st, 2024, the following is a newly-recognized L-code:

• L5783: "Addition to lower extremity, user adjustable, mechanical, residual limb volume management system."

As of the date of writing, the state-specific fees for L5783 have not been published, but the HCPCS Coding Workgroup has previously announced that the new L code's 2024 average fee schedule amount will be roughly $3,017.00.

This news was expected, as Medicare had previously announced its intent to create a code describing this kind of system during the 2023 second-half coding cycle. However, as sometimes happens, Medicare began the calendar year without yet having created a specific code, meaning that you had to submit claims in Q1 using L5999 if you were providing this to your patients. Effective April 1st, that is no longer the case.

What this Means for You

First, it's important for you to understand the core elements of this code. The residual limb volume management system you integrate into the socket must be user-adjustable in order to qualify for L5783. If patients cannot control the system themselves, you cannot use this code.

Second, it must be a mechanical system. Make sure that if you intend to use a system like this in a prosthetic socket, you include specific information detailing the patient's current volume changes and how those changes affect their ability to use their prosthesis. You need to establish the medical necessity of this system for your specific patient, which includes both their relevant clinical history and how the inability to control volume previously has led to identifiable clinical issues that this will remedy.

Finally, there are no specific coverage criteria that the DME MACs or PDAC have published at this time for this code (e.g., functional level restrictions, etc.) We will continue to monitor that for you and will provide updates if and when they become available.