Question 1

What is HCPCS code L5859?

Accepted Answer

HCPCS code L5859 is "Knee-shin pro flex/ext cont". Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s)

Question 2

What category is L5859 in?

Accepted Answer

L5859 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L5859?

Accepted Answer

Use L5859 when billing for knee-shin pro flex/ext cont. 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 L5859 covered by Medicare?

Accepted Answer

Coverage for L5859 (Knee-shin pro flex/ext cont) 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 L5859?

Accepted Answer

Documentation for L5859 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).