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Correct Coding Instructions – Endolite Echelon® Prosthetic Foot

This article serves as notification to suppliers of the appropriate coding guidelines for billing the Endolite Echelon® prosthetic foot. The following Healthcare Common Procedure Coding System (HCPCS) codes, as assigned by the Centers for Medicare and Medicaid Services (CMS) Alpha Numeric Work Group effective January 1, 2011, must be used:

L5968 ADDITION TO LOWER LIMB PROSTHESIS, MULTIAXIAL ANKLE WITH SWING PHASE ACTIVE DORSIFLEXION FEATURE

L5981 ALL LOWER EXTREMITY PROSTHESES, FLEX-WALK SYSTEM OR EQUAL

These are the only codes that are used to describe the Echelon® prosthetic foot. Use of any other code(s), including the miscellaneous code L5999, is incorrect. Specifically, code L5999 must not be used to reflect “Hydraulic ankle with independent variable plantar and dorsi-flexion adjustment, fluid stance phase control continuous” or “Hydraulic fluid, self aligning feature” as instructed by the manufacturer, Endolite. This function is included in the payment for L5968.

All current DME products coded by the PDAC are found on the PDAC website on Durable Medical Equipment Coding System (DMECS), https://www.dmepdac.com/dmecsapp/do/search. For questions about correct coding, contact the PDAC Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form located on the PDAC website: https://www.dmepdac.com/.

Date Posted 03/17/11