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2025 HCPCS code L5972

All lower extremity prostheses, foot, flexible keel.

Modifiers may be applicable to provide additional information about the services provided. For example, modifiers may indicate the functional level of the patient or if the prosthesis is a replacement.

Medical necessity for the L5972 flexible keel foot must be established by demonstrating that the patient has a lower extremity amputation or deficiency that impairs ambulation, and that the flexible keel foot is the most appropriate prosthesis to restore function and mobility. The functional level of the patient (e.g. K2 level) and the clinical rationale for choosing a flexible keel design over other options must be clearly documented.

In simple words: This code is for a type of prosthetic foot with a flexible keel that helps absorb shock and allows for better walking on uneven surfaces.

This code represents a flexible keel foot prosthesis for lower extremity. A flexible or elastic keel absorbs shock and cushions the foot, allowing the forefoot to conform to uneven terrain while maintaining stability. It is commonly used as a preparatory prosthesis and is often later replaced by a more dynamic foot type.

Example 1: A patient with a below-knee amputation requires a prosthetic foot for ambulation on uneven terrain. The L5972 flexible keel foot is chosen for its stability and shock absorption., An individual with a transtibial amputation is fitted with a preparatory prosthesis using the L5972 flexible keel foot. This allows them to begin ambulation training while awaiting a more definitive prosthesis., A patient with an ankle disarticulation requires a prosthetic foot that can accommodate moderate impacts. The L5972 flexible keel foot is deemed suitable for their functional level.

Documentation should support the medical necessity for the flexible keel foot prosthesis, including the patient's functional level, ambulation goals, and the assessment of the suitability of this type of prosthesis for their specific needs. The documentation must confirm that the patient's condition requires a flexible keel prosthetic and not an alternative type.

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