2025 HCPCS code L5614
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Prosthetic Procedures - Lower Extremity Prostheses Orthotics and Prosthetic Devices Feed
Addition to a lower extremity endoskeletal system (above-knee/knee disarticulation); 4-bar linkage with pneumatic swing phase control.
Modifiers may apply depending on the circumstances of service. Consult the most up-to-date modifier guidelines.
Medical necessity for L5614 would be established by demonstrating that the patient's functional limitations warrant the use of a more advanced prosthetic knee joint with pneumatic swing phase control.Documentation should show that simpler prosthetic options have been considered and found insufficient to meet the patient's needs.The improved gait and ambulation resulting from the addition of L5614 should be documented and support the medical necessity.
The clinical responsibility involves the fitting and assessment of the prosthetic device, ensuring proper alignment and function, and instructing the patient on its use.A prosthetist or orthotist would typically be responsible.Post-operative care and follow-up may also be involved.
- Orthotics and Prosthetic Devices
- L5000-L9900 > Endoskeletal Prosthetic Additions, Lower Extremities L5610-L5617
In simple words: This code covers adding a special knee joint to an artificial leg for people who have had their leg amputated above the knee or at the knee.This improved knee joint helps them walk more naturally and easily.
This HCPCS code, L5614, represents the addition of a four-bar linkage knee prosthesis with a pneumatic swing phase control system to a lower extremity endoskeletal prosthesis.This is specifically for patients with above-knee or knee disarticulation amputations. The four-bar linkage allows for controlled bending of the knee during the swing phase of gait, improving clearance and ease of movement. The pneumatic control system regulates the speed and smoothness of walking. The code encompasses the components and procedures involved in adding this advanced control system to an existing or new prosthesis.
Example 1: A patient with a transfemoral amputation (above-knee amputation) requires a more advanced prosthetic knee joint to improve gait and ambulation.The four-bar linkage with pneumatic control, billed under L5614, provides improved swing phase control and reduces the effort needed for walking., A patient with a knee disarticulation amputation experiences difficulty with prosthetic knee stability during the swing phase.The addition of the L5614 prosthesis improves gait smoothness and reduces the risk of tripping or stumbling., A young, active patient with a transfemoral amputation needs a prosthesis that can withstand high-impact activities.The durable construction of the four-bar linkage knee, coupled with the pneumatic control (L5614), offers both functionality and robustness for a more active lifestyle.
Detailed documentation should include the type of amputation (transfemoral or knee disarticulation), the patient's functional level, and a justification for the selection of the four-bar linkage with pneumatic control over simpler prosthetic knees.Pre- and post-operative assessments, including gait analysis, should be documented.The manufacturer and model number of the prosthesis should be recorded.
** Always refer to the most current HCPCS coding guidelines and payer-specific requirements for accurate billing and reimbursement.This information is for guidance only and should not be considered definitive medical advice.
- Revenue Code: Not specified in provided data.
- RVU: Not specified in provided data.
- Global Days: Not specified in provided data.
- Payment Status: Active
- Modifier TC rule: Not specified in provided data.
- Fee Schedule: Not specified in provided data.
- Specialties:Prosthetics and Orthotics, Physical Medicine and Rehabilitation, Surgery (Orthopedic, Vascular)
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center