Question 1

What is HCPCS code L4070?

Accepted Answer

HCPCS code L4070 is "Replace prox & dist upright". Replace proximal and distal upright for kafo

Question 2

What category is L4070 in?

Accepted Answer

L4070 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L4070?

Accepted Answer

Use L4070 when billing for replace prox & dist upright. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is L4070 covered by Medicare?

Accepted Answer

Coverage for L4070 (Replace prox & dist upright) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for L4070?

Accepted Answer

Documentation for L4070 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).