Question 1

What is HCPCS code L5312?

Accepted Answer

HCPCS code L5312 is "Knee disart, sach ft, endo". Knee disarticulation (or through knee), molded socket, single axis knee, pylon, sach foot, endoskeletal system

Question 2

What category is L5312 in?

Accepted Answer

L5312 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L5312?

Accepted Answer

Use L5312 when billing for knee disart, sach ft, endo. 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 L5312 covered by Medicare?

Accepted Answer

Coverage for L5312 (Knee disart, sach ft, endo) 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 L5312?

Accepted Answer

Documentation for L5312 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).