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Linda Collins Blogger

L5930: Ancient History You Need to Know

Posted by Linda Collins | May 06, 2013

We continue to get regular questions about the appropriate use of L5930 (“high activity knee control frame”) from prosthetists around the United States. While Medicare’s guidance about this code qualifies as “old news,” we thought a quick and clear description of the applicable requirements would help.

In 2006, each of the 4 DME MACs adopted the following policy: prosthetists can only bill L5930 for K4 level patients. You can find this requirement in the Local Coverage Decision for your Medicare region.

Recently, the Recovery Auditors have cracked down on the use of this code. They are demanding that suppliers provide documentation substantiating the patient’s K level. If the documentation doesn’t exist or doesn’t demonstrate the patient’s K4 status, the Recovery Auditors are recouping the payments for L5930.

What do you need to do?

You and your staff should review the LCD for your region. You can access the Medicare database to search for these documents by clicking here.

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