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Click Medical Secures Two Coveted L-Codes: L5783 & L7406
Breaking News - Effective January 13th, 2025
Click Medical proudly announces the approval of two critical HCPCS codes by CMS, expanding coverage and reimbursement for its innovative RevoFit technology to ALL prosthetics.
L5783 (Effective April 1, 2024):
This code applies to custom adjustable lower-extremity sockets with RevoFit, enabling users to manually adjust socket volume throughout the day for enhanced comfort and fit. Reimbursement for L5783 is set at $3,015.92 for 2024.
CMS policy article 52496 describes L5783 as: “A complete mechanical product used as an addition to the current lower extremity prosthetic base socket and socket replacement codes. This system is a kit of components (reel, cable, or similar) incorporated into a custom-fabricated socket. The predicate product is RevoFit, manufactured by Click Medical.”
L7406 (Effective April 1, 2025)
Newly approved, this code extends RevoFit’s benefits to upper-extremity prosthetics. Reimbursement for L7406 is set at $3,088.30.
With these approvals, RevoFit adjustability is now covered for both upper and lower extremity prosthetics, offering comprehensive support for individuals with limb loss or limb difference.
Click Medical thanks industry experts and partners for their support and appreciates CMS’s recognition of the transformative impact of adjustability.
U.S. Insurance Coding
RevoFit® & RevoSurface®
Custom Lower Extremity Prosthesis - L5783: Addition to lower extremity, user adjustable, mechanical, limb volume management system. Applicable to all LE amputation levels across all activity levels. Appropriate for new, replacement, and preparatory sockets.
Custom Upper Extremity Prosthesis - New Code Effective 04/01/2025, L7406: Addition to upper extremity, user adjustable, mechanical, residual limb volume management system to describe RevoFit®. Prior to 04/01/2025, continue to utilize L7499 (Reference L5783 as Same/Similar and pending activation of L7406), and, supply Click Medical’s RevoFit MSRP for upper extremity prosthetic devices and our suggested descriptive language.
Custom Orthosis - L2999 (Reference L5783 as Same/Similar): Additionally, utilize Click Medical’s RevoFit MSRP for orthotic devices and our suggested descriptive language. Appropriate for new, replacement, and modified Dynamic AFO and KAFO custom laminated devices.
Repair of an Existing Prosthesis - L7510: For cost of materials and L7520 for repair labor components. Appropriate for RevoFit replacement parts and labor to install.
Repair of an Existing Orthosis - L4210: For cost of materials and L4205 for repair labor components. Appropriate for RevoFit replacement parts and labor to install.
RevoLock®
Lower Extremity Prosthesis - L5671: Addition to lower extremity, below knee/above knee suspension locking mechanism (shuttle, lanyard, or equal), excludes socket insert.
Upper Extremity Prosthesis - L6698: Addition to upper extremity prosthesis, below elbow/above elbow, lock mechanism, excludes socket insert.
Repair of an Existing Prosthesis - L7510: For cost of materials and L7520 for repair labor components. Appropriate for RevoLock replacement parts and labor to install.
Repair of an Existing Orthosis - L4210: For cost of materials and L4205 for repair labor components. Appropriate for RevoLock replacement parts and labor to install.
QuickFit®
Lower Extremity Custom Orthosis - L2320: Addition of lacer to lower extremity, non-molded lacer, for custom fabricated orthosis only.
Lower Extremity Custom Orthosis - L2330: Addition of lacer
to lower extremity, lacer molded to patient model, for custom fabricated orthosis.
Orthotic Shoes - L2999 (Reference L3580 as Same/Similar): Addition of lacer to orthopedic shoe, convert instep to velcro closure.
Addition to/Repair of Orthosis - L4002: Replacement strap for any orthosis that includes all components and can be any length or type.
FAQs
When utilizing RevoFit®, our customers often ask:
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:
- In the absence of a negotiated fee schedule, submit the RevoFit Lower Extremity MSRP price of $4495 under the insurance and coding section
- 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
- 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.
