HCPCS code L5856 — Elec knee-shin swing/stance.
Status: Active.
Effective Jan 1, 2005.
Source: CMS HCPCS Level II.
L5856
ActiveElec knee-shin swing/stance
Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type
Category:
Orthotics & Prosthetics
Section:
L-codes: Orthotic and Prosthetic Procedures
Effective:
Jan 1, 2005
Code type:
alphanumeric
OPPS Status:
A
— Paid under a separate fee schedule (not OPPS)
Medicare Part B utilization — 2023
Services billed
18,400
Beneficiaries
16,800
Medicare paid
$73,600,000
Avg per service
$5,000.00
Source: Medicare Part B Provider Utilization Public Use File (anonymized, aggregated to HCPCS level).
MUE — Medically Unlikely Edits
Maximum units of L5856 Medicare will pay for one beneficiary on one date of service. Claims exceeding the MUE are denied or returned for review.
| Service Type | Max Units / Day |
|---|---|
| DME Supplier | 2 |
| Outpatient Hospital | 2 |
| Practitioner Services | 0 |
Source: CMS Medicare NCCI Medically Unlikely Edits