Question 1

What is HCPCS code L5811?

Accepted Answer

HCPCS code L5811 is "Endo knee-shin mnl lck ultra". Addition, endoskeletal knee-shin system, single axis, manual lock, ultra-light material

Question 2

What category is L5811 in?

Accepted Answer

L5811 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L5811?

Accepted Answer

Use L5811 when billing for endo knee-shin mnl lck ultra. 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 L5811 covered by Medicare?

Accepted Answer

Coverage for L5811 (Endo knee-shin mnl lck ultra) 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 L5811?

Accepted Answer

Documentation for L5811 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).