Question 1

What is HCPCS code L5020?

Accepted Answer

HCPCS code L5020 is "Tibial tubercle hgt w/ toe f". Partial foot, molded socket, tibial tubercle height, with toe filler

Question 2

What category is L5020 in?

Accepted Answer

L5020 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L5020?

Accepted Answer

Use L5020 when billing for tibial tubercle hgt w/ toe f. 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 L5020 covered by Medicare?

Accepted Answer

Coverage for L5020 (Tibial tubercle hgt w/ toe f) 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 L5020?

Accepted Answer

Documentation for L5020 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).