Question 1

What is HCPCS code L5100?

Accepted Answer

HCPCS code L5100 is "Molded socket shin sach foot". Below knee, molded socket, shin, sach foot

Question 2

What category is L5100 in?

Accepted Answer

L5100 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L5100?

Accepted Answer

Use L5100 when billing for molded socket shin sach foot. 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 L5100 covered by Medicare?

Accepted Answer

Coverage for L5100 (Molded socket shin sach foot) 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 L5100?

Accepted Answer

Documentation for L5100 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).