Question 1

What is HCPCS code L5631?

Accepted Answer

HCPCS code L5631 is "Ak/knee disartic acrylic soc". Addition to lower extremity, above knee or knee disarticulation, acrylic socket

Question 2

What category is L5631 in?

Accepted Answer

L5631 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L5631?

Accepted Answer

Use L5631 when billing for ak/knee disartic acrylic soc. 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 L5631 covered by Medicare?

Accepted Answer

Coverage for L5631 (Ak/knee disartic acrylic soc) 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 L5631?

Accepted Answer

Documentation for L5631 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).