Unlocking Opportunities: Lessons From HCPCS Code Success at Click Medical – Featured on NCOPE

At Click Medical, we believe providers are the true heroes driving meaningful change within the orthotic and prosthetic (O&P) industry. You are the ones who see firsthand how innovative products impact patient lives through every detail, every success, and every challenge. That is why we want to share our journey to secure HCPCS codes L5783 and L7406.

Our goal? To inspire you to champion and advocate for codes that support the tools and technologies you believe in.

Traditionally, manufacturers have led the push for new HCPCS codes, but what if there is a better way? Providers, with intimate knowledge of patient outcomes and product performance, are uniquely positioned to lead the charge. You have the full story—from prescription to outcomes—and can collaborate with industry partners to ensure reimbursement for the innovations that truly make a difference.

“So, how can providers work together to challenge the status quo and influence the future of this industry?”

Below are the steps, strategies, and lessons we have learned.

Reimbursement Challenges:

When considering reimbursement challenges, it is important to understand your options. If a product fits within the description of an existing code (or a combination of codes), pursuing PDAC (Pricing, Data Analysis, and Coding) approval is the best route. However, if no existing code adequately describes the product, the next step is to request a new HCPCS code. This process requires substantial research, compelling evidence, and a clear distinction from other products on the market.

Before pursuing new coding, be sure to assess whether the product is truly distinct and gather extensive history, evidence, and research to support your case.

“You will never know what is possible until you try.”

A positive decision can mean game-changing access to products for patients and providers alike. However, there are risks, including PDAC denial, which could highlight the need for a new code but might also hinder short-term progress. HCPCS denial could relegate a product to “miscellaneous” codes, resulting in low reimbursement rates or limited coverage that stalls adoption. Even success can come with caveats, as approval might include constraints such as limited beneficiary groups or poor reimbursement rates. Despite the challenges, the journey is worth it—and we have proof.

Click Medical is thrilled to announce that the Centers for Medicare and Medicaid Services (CMS) have approved two critical HCPCS codes: L5783 and L7406. These two codes expand coverage and reimbursement for the Click Medical innovative RevoFit technology to BOTH lower and upper extremity prosthetics. These approvals are the result of years of effort and collaboration, made possible by the unwavering support of our community. We are excited to share the valuable lessons learned along the way.

L5783, effective April 1, 2024, applies to custom adjustable lower-extremity sockets with RevoFit, allowing users to manually adjust socket volume throughout the day for improved comfort and fit. With a reimbursement value set at $3,088.30, L5783 represents a significant milestone in making advanced prosthetic solutions accessible to more individuals.

Building on the success of L5783, CMS also approved L7406, effective April 1, 2025. This code brings RevoFit adjustability to upper-extremity prosthetics, with reimbursement set at $3,088.30. This approval further solidifies RevoFit as a comprehensive solution for individuals with limb loss or limb difference, addressing volume fluctuations, atypical limb shapes, redundant tissue, and limb sensitivities.

What we learned about building and constructing a compelling case.

• Acquire help by leveraging industry consultants and advisors to navigate the complexities of the process.
• Collaborate with providers and technicians to gather real-world evidence.
• Simplify your message by communicating in clear, concise, and visual language that resonates with decision-makers.
• Above all, be persistent! Coding and reimbursement processes require patience and perseverance, so do not give up.

“Your expertise and real-world perspective give you the credibility to advocate for new codes.”

By collaborating with manufacturers, consultants, and other providers, you can drive innovation in O&P care, ensure reimbursement for products that improve patient outcomes, and impact the industry for the better.

Do you believe in a product that is not yet covered? Take the first step today: research the coding and reimbursement process, build partnerships with manufacturers and other providers, and advocate for the tools that transform patient care.

“At Click Medical, we’re here to support you on this journey. Together, we can make adjustability and other groundbreaking solutions more accessible to all. Let’s reshape the future of O&P—one code at a time.”

Find more information at ClickMedical.com and @ClickMedical on Facebook, Instagram, LinkedIn.