Question 1

What is HCPCS code L5430?

Accepted Answer

HCPCS code L5430 is "Postop dsg ak ea add cast ch". Immediate post surgical or early fitting, application of initial rigid dressing, incl. fitting, alignment and supension, 'ak' or knee disarticulation, each additional cast change and realignment

Question 2

What category is L5430 in?

Accepted Answer

L5430 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L5430?

Accepted Answer

Use L5430 when billing for postop dsg ak ea add cast ch. 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 L5430 covered by Medicare?

Accepted Answer

Coverage for L5430 (Postop dsg ak ea add cast ch) 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 L5430?

Accepted Answer

Documentation for L5430 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).