Question 1

What is HCPCS code L5505?

Accepted Answer

HCPCS code L5505 is "Init ak ischal plstr direct". Initial, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed

Question 2

What category is L5505 in?

Accepted Answer

L5505 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L5505?

Accepted Answer

Use L5505 when billing for init ak ischal plstr direct. 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 L5505 covered by Medicare?

Accepted Answer

Coverage for L5505 (Init ak ischal plstr direct) 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 L5505?

Accepted Answer

Documentation for L5505 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).