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2025 HCPCS code L5856

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type.

This code is specifically for the addition of the microprocessor control feature and should not be billed separately if included as part of a complete knee-shin system. Ensure appropriate modifiers are used to indicate any additional features or services provided.

Medical necessity is established by documenting the patient's functional limitations and the need for improved gait and stability. The microprocessor-controlled knee should be justified based on the patient's specific needs and abilities, including their amputation level and activity level.

This device is prescribed by a provider for patients with transfemoral or knee disarticulation amputations. Patients using this device must be capable of relatively fast and frequent walking activities and must be able to feel vibrations and hear acoustic signals from the microprocessor.

IMPORTANT:L5857 - Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any typeL5858 - Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, stance phase only, includes electronic sensor, any typeL5973 - Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power sourceL5980 - All lower extremity prostheses, flex foot systemL5987 - All lower extremity prosthesis, shank foot system with vertical loading pylon

In simple words: This code is for a special computerized part added to an artificial leg, specifically for the knee-shin area. It helps the leg move more naturally by using sensors to control the swing and stance phases of walking.

This code represents the addition of a microprocessor control feature with electronic sensors for swing and stance phase to an endoskeletal knee-shin system lower extremity prosthesis. This device uses a battery-operated, microprocessor-controlled hydraulic knee that continually analyzes data provided by electronic sensors, thus controlling the swing and stance phase of the patient’s gait.The microprocessor control feature assists the patient in walking efficiently on irregular surfaces as well as in climbing and descending stairs. This knee system is used with an endoskeletal prosthesis system, which has an internal support mechanism.

Example 1: A patient with a transfemoral amputation requires a prosthesis with a microprocessor-controlled knee to enhance their gait and stability, especially on uneven terrain., An active individual with a knee disarticulation amputation needs a prosthesis that allows for variable cadence and the ability to traverse environmental barriers, making L5856 a suitable option., A patient who has undergone a transfemoral amputation and has difficulty with stairs and slopes would benefit from the swing and stance phase control offered by the microprocessor knee.

Documentation should include the type of amputation, the patient's functional level, and the medical necessity for the microprocessor-controlled knee, including the patient's ability to utilize the sensory feedback provided by the device. Justification for swing and stance phase control should also be included.

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