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Six L Codes Added To Required Prior Authorization List

On February 11, CMS added six L codes for lower limb prosthetics to the Required Prior Authorization (PA) List:

  • L5856: Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type
  • L5857: Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type
  • L5858: Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type
  • L5973: Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source
  • L5980: All lower extremity prostheses, flex foot system
  • L5987: All lower extremity prosthesis, shank foot system with vertical loading pylon

PA for the six L codes will be implemented in two phases. Starting on May 11, 2020, PA will be implemented only in California, Michigan, Pennsylvania, and Texas to assess if there are any unforeseen issues. The plan is to then implement it nationally on October 8, 2020.
 
The PA program will continue for the 45 PMD and support surfaces codes. You can find the Federal Register announcement here.

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