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2025 HCPCS code L5858

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature with electronic sensors for stance phase.

Refer to HCPCS coding guidelines for proper usage and reporting of L-codes, including any applicable modifiers.

Modifiers may be applicable. Consult modifier guidelines for specific scenarios.

Medical necessity must be established by demonstrating that the patient's functional limitations due to the amputation significantly impact their mobility and quality of life, and that the microprocessor-controlled knee is necessary to improve their ambulation and safety.

The prescribing provider determines the need for this device based on the patient's amputation level, functional abilities, and gait requirements. They must ensure the patient can use the device safely and effectively.

IMPORTANT:L5856: Microprocessor control for swing and stance phase. L5857: Microprocessor control for swing phase only.

In simple words: This code covers a special computer-controlled part added to an artificial leg, specifically for the knee and shin. It helps the user walk more naturally by using sensors to adjust the leg's movement when the foot is on the ground.

This code represents the addition of a microprocessor control feature with electronic sensors for the 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 stance phase of the patient's gait.It is prescribed for patients using a prosthesis after a transfemoral or knee disarticulation amputation, who are capable of relatively fast and frequent walking activities, and can feel vibrations and hear acoustic signals from the microprocessor. The microprocessor helps with walking on irregular surfaces and stairs.The system is used with an endoskeletal prosthesis, which has an internal support mechanism.

Example 1: A patient with a transfemoral amputation requires a more advanced prosthetic knee to improve stability and mobility on uneven terrain. The L5858 code is used for the microprocessor-controlled knee component that enhances stance phase control., An active individual with a knee disarticulation amputation needs a prosthesis that allows for variable cadence and high-impact activities. The L5858 microprocessor knee is added to their endoskeletal prosthesis to provide the necessary control and stability., Following a transfemoral amputation, a patient has difficulty navigating stairs and inclines.The L5858 code is used to bill for the addition of the microprocessor-controlled knee to their prosthesis, enabling improved stance phase control and facilitating safer ambulation on varied surfaces.

Documentation should support the medical necessity of the microprocessor-controlled knee, specifying the patient's functional limitations and the expected benefits of the device.The amputation level, gait analysis findings, and the patient's ability to use the advanced features should also be documented.

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