Question 1

What is HCPCS code L5857?

Accepted Answer

HCPCS code L5857 is "Elec knee-shin swing only". Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type

Question 2

What category is L5857 in?

Accepted Answer

L5857 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L5857?

Accepted Answer

Use L5857 when billing for elec knee-shin swing only. 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 L5857 covered by Medicare?

Accepted Answer

Coverage for L5857 (Elec knee-shin swing only) 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 L5857?

Accepted Answer

Documentation for L5857 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).