L5783 - Addition to Lower Extremity, user adjustable, mechanical, residual limb volume management system

$3015.92, Effective April 1, 2024

Medicare: Effective April 1, 2024
Medicare Advantage: Effective April 1, 2024, will follow existing MA-provider contracts and fee schedules
VA (TriCare): Effective April 1, 2024, will follow existing VA-provider contracts and fee schedules
Commercial / Private Payers: While everyone will recognize the code, it will take time to update systems, coverage, etc. New codes could be subject to payer-provider contracts (% of Medicare is common); Plan to file appeals in the short term, as claims may be denied until systems are updated
Medicaid, Managed Medicaid: State by State (we have not done an in-depth analysis, but suggest billing with new code, appealing and pushing for coverage)

Prior to coverage and fee schedules being finalized, some tips include:

1. In the absence of a negotiated fee schedule, submit the RevoFit Lower Extremity MSRP price of $4495 under the insurance and coding section
2. Proactively reach out to payer contacts to notify them of the new code and expected utilization and expected benefit (saves patient visits and socket remakes, per the Medicare decision to award a new HCPCS code) - helpful tips available on our website
3. Full documentation (examples and suggestions) for prior authorization and/or appeals is available on the website

We are investigating, but 3D printed, and perhaps preparatory sockets will be covered; we are unsure about socket modifications (after delivery) with the RevoSurface, but also investigating.

No, the RevoLock System is coded as suspension (L5671 - Lower Extremity & L6698 - Upper Extremity); RevoSurface may be covered under L5783 but will likely depend on the application, timing, and PDAC ruling.

We do not have an answer, that is up to PDAC.

No, at this time L5783 has been issued and is for LE prostheses only. Click Medical intends to pursue a similar upper extremity code provision, timing is TBD. It is reasonable to bill with the L7499 for coding upper extremity adjustable sockets with RevoFit, with reference to L5783 and the same/similar volume management function and benefit for upper extremity. Include the RevoFit Upper Extremity MSRP

No, at this time L5783 has been issued and is for LE prosthetics only. Click Medical intends to pursue a similar orthotic code provision, timing is TBD.

At this time, there are no known restrictions, but typically our understanding is that an “addition to” code may only appear on a claim one time. There have been instances where practitioners have reported billing for multiple systems with the L5999 code, and with proper justification have been paid accordingly. Documentation will need to support the justification for 2 distinctly different volume management solutions on the same socket.

Submit the RevoFit MSRP, available on our website under the insurance and coding section of RevoFit. In the absence of a fee schedule, it is common for payers to take a standard % from this amount until fee schedules are updated.

Simple language, such as, ‘patient has ongoing need for an adjustable socket system in order to address issues related to volume fluctuation and to reduce the need for frequent socket replacement.’ Or ‘Rx for right side BKA socket replacement with adjustable feature to accommodate volume fluctuations as medically necessary for patient.” Is recommended.