October 7, 2016

DME MACs Revise C-Leg Coding

Content provided by The O&P EDGE
Current Issue - Free Subscription - Free eNewsletter - Advertise

The four Durable Medical Equipment Medicare Administrative Contractors (DME MACs) issued a joint publication with revised coding for the Ottobock C-Leg, which is covered by Medicare for beneficiaries classified as K-level 3 or 4. The Healthcare Common Procedure Coding System (HCPCS) code determination was reevaluated at the manufacturer’s request. Effective for claims with dates of service on or after October 6, only the following codes may be used to bill Medicare for this product:

  • L-5828: addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control
  • L-5845: addition, endoskeletal, knee-shin system, stance flexion feature, adjustable
  • L-5848: addition to endoskeletal knee-shin system, fluid stance extension, dampening feature, with or without adjustability
  • L-5856: addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type

According to the revised coding publication, this group of four codes is all-inclusive (i.e., they describe all features and functions of the C-Leg), and no other codes should be used.

For more information, refer to the Local Coverage Determination for Lower Limb Prostheses and related Policy Article. For questions about correct coding, contact the Pricing, Data Analysis and Coding (PDAC) contractor contact center at 877.735.1326, or send an e-mail by completing the DME PDAC Contact Form.

Bookmark and Share