Question 1

What is HCPCS code L5795?

Accepted Answer

HCPCS code L5795 is "Exoskel hip ultra-light mate". Addition, exoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)

Question 2

What category is L5795 in?

Accepted Answer

L5795 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L5795?

Accepted Answer

Use L5795 when billing for exoskel hip ultra-light mate. 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 L5795 covered by Medicare?

Accepted Answer

Coverage for L5795 (Exoskel hip ultra-light mate) 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 L5795?

Accepted Answer

Documentation for L5795 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).