Skip navigation
9

David McGill Blogger

The 2013 L-Codes: A Summary

Posted by David McGill | November 06, 2012

Monday, Medicare officially announced the L code update for 2013. With respect to lower extremity prosthetic codes, it is mercifully simple.

  • Medicare did not delete any already-existing L codes.
  • Medicare modified the language of L5972 to eliminate references to manufacturers’ specific products, but otherwise left the descriptor the same.

But in what is the biggest news for 2013, Medicare announced its final decision to create a new L code describing a powered knee joint: L5859. The new code reads as follows:

Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s)

The significance of this decision is that it marks the first time that a motor-powered and programmable lower extremity joint has been recognized by Medicare as deserving of an L code. And we are proud to report that the application giving rise to this new code was submitted by Össur’s for its POWER KNEE, the first motor-powered knee joint available to above-knee amputees in the United States.

The new code will become effective on January 1, 2013. Pricing for the code remains unknown at this time, as Medicare has not yet unveiled the 2013 HCPCS Fee Schedule. That decision could come as early as the next month or so, but Medicare could choose to wait until sometime in 2013 to announce the fee for L5859.

So what does this mean for you?

1. Billing Medicare for POWER KNEE Between Now and January 1, 2013

Based upon the guidance from the HCPCS Coding Workgroup and its final decision regarding the POWER KNEE, Össur suggests the following codes for POWER KNEE claims submitted between now and January 1, 2013:

L-Code Description
L5856 Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type
L5999 Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s)
L5828 ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING AND STANCE PHASE CONTROL
L5845 ADDITION, ENDOSKELETAL, KNEE-SHIN SYSTEM, STANCE, STANCE FLEXION FEATURE, ADJUSTABLE
L5848 ADDITION TO ENDOSKELETAL KNEE-SHIN SYSTEM, FLUID STANCE EXTENSION, DAMPENING FEATURE, WITH OR WITHOUT ADJUSTABILITY

2. Billing Medicare for POWER KNEE Effective January 1, 2013

Based upon the HCPCS Coding Workgroup’s final decision, you should use the following codes when billing Medicare for POWER KNEE effective January 1, 2013:

L-Code Description
L5856 Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type
L5859 Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s)
L5828 ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING AND STANCE PHASE CONTROL
L5845 ADDITION, ENDOSKELETAL, KNEE-SHIN SYSTEM, STANCE, STANCE FLEXION FEATURE, ADJUSTABLE
L5848 ADDITION TO ENDOSKELETAL KNEE-SHIN SYSTEM, FLUID STANCE EXTENSION, DAMPENING FEATURE, WITH OR WITHOUT ADJUSTABILITY

Össur would like to thank Medicare’s HCPCS Coding Workgroup for its consideration of our application.

Össur R&R

The Source for O&P Reimbursement & Regulatory News & Analysis

If you have any questions for Össur’s Reimbursement Team or about Össur’s Reimbursement Services, please contact us at reimbursement411@ossur.com