Original Question:
I am curious regarding the use of L-5940/L5950. These codes are transtibial/transfemoral ultra light material and was curious how exactly they are to be used or how the practitioner population is using them. I have heard recently that CMS has stated that these L-codes are to only be used with socket replacement codes. Has anyone else heard anything about theses codes? Can these codes be used with a new prosthesis or replacement of major parts? Any feedback is much appreciated!
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Thanks for all the great responses in regards to these codes. You will find the responses below.
Responses:
1. For Medicare, they can be used for any socket, excluding preparatory but are not allowed for components any longer. It basically refers to the use of carbon fiber now. However, private insurance, feel free to use them more liberally… for now.
2. These codes are to be used when your making a Definitive, Temporary or
replacement socket when you are lying it up with Carbon braid/stripes and
Fiberglass layup.
3. It’s spelled out in CMS local coverage determination Article A25528 effective April 10, 2010: L5940-L5960 codes are for ultra-light materials (carbon fiber, fiberglass, Kevlar, other advanced composite lamination materials) used in fabrication of endoskeletal prosthetic socket..
4. I think I read that they could be used once per base code which I take to mean either new socket or socket replacement.
5. We always use those codes with socket replacements as well as new
prostheses, assuming that we have utilized carbon fiber and titanium
components. I don’t recall ever using them for replacement of major parts, but we may have to evaluate their use in these situations as well. I have always understood these codes as attempting to offset the additional cost entailed in using carbon (as opposed to fiberglass or wood) and titanium (in lieu of steel and aluminum) in our prosthetic designs. I think of it kind of like the total contact code as being reimbursement for the additional time and energy required to achieve true total contact or the acrylic socket code as offsetting the expense of using acrylic resin as opposed to old school polyester resin.
6. I have read on the CMS website that ultra light mat can be used on def. Sockets and replacements. One can’t used the L5940/L5950 for prep/ temp sockets. Hope this helps.
http://www.oandp.com/reference/L5940-L5960_and_other_policies.pdf
This link is an article regarding these L-codes and others that I have included which was extremely helpful and I believe all of you can benefit from taking a look at it. Let me know if you have any questions or information regarding this topic.
Have a blessed day!
Sharidy MacCord, CP
Virginia Prosthetics
