Retired - Coding Instructions - Microprocessor Controlled Knee Prostheses

Recently coding instructions were provided for the Otto Bock C-Leg® and the billing of miscellaneous code L5999 for two functions, "continuous gait assessment, computerized MKP prosthesis" and "electronically controlled static stance regulator, adjustable." There are additional products with microprocessor control of stance and swing phase (Endolite Adaptive® knee and Ossur Rheo® knee), swing phase only (Endolite Smart IP®, Endolite IP+®) or stance phase only (Otto Bock Compact® knee) to which the coding guidance previously published for the Otto Bock C-Leg® applies.

Use of miscellaneous code L5999 reflecting either "continuous gait assessment, computerized microprocessor controlled knee prosthesis" or "electronically controlled static stance regulator, adjustable" is incorrect. Since these functions are included in the payment for L5856, L5857 or L5858, the correct coding is L9900 (Orthotic and prosthetic supply, accessory and/or service component of another HCPCS "L" code).

For the Otto Bock C-Leg®, the following are considered unbundled from code L5856:

• L5999 - Electronically controlled static stance regulator, adjustable
• L5999 - Continuous gait assessment, computerized microprocessor knee prosthesis

For the Endolite Adaptive® knee and Ossur Rheo® knee, the following is considered unbundled from code L5856:

• L5999 - Continuous gait assessment, computerized microprocessor knee prosthesis

For the Endolite Smart IP®, Endolite IP+®, the following is considered unbundled from code L5857:

• L5999 - Continuous gait assessment, computerized microprocessor knee prosthesis

For the Otto Bock Compact® knee, the following is considered unbundled from code L5858:

• L5999 - Continuous gait assessment, computerized microprocessor knee prosthesis

For all of the products listed above, if a supplier chooses to bill for those functions shown as L5999, code L9900 must be used and will be denied as unbundled.

Suppliers are reminded that for any questions regarding the correct coding of products to access the Durable Medical Equipment Coding System (DMECS) https://www4.palmettogba.com/pdac_dmecs/ or contact the Pricing, Data Analysis, and Coding (PDAC) Contact Center at 877-735-1326.