Power Knee Coding Change Coming

What You Need to Know

Medicare’s Coding Workgroup recently approved a new L code for Power Knee that will replace 3 of the 5 existing L codes that historically applied to this device. The Workgroup made its decision because it wanted to more accurately describe Power Knee’s electromechanical control features, rather than continue using multiple codes designed for fluid-controlled prosthetic knees.

The fee schedule for this new code is projected at approximately $7,072.52, which is the aggregated average value of  the combined fees for the 3 HCPCS codes historically verified for Power Knee: L5828, L5845, and L5848. The new code LXXXX will join L5856 and L5859 as a three-code set that describe Power Knee in its entirety.

What this Means for You

1. Total Reimbursement Remains Unchanged. Because Medicare has crosswalked the combined value of L5828, L5845, and L5848 to create the fee schedule amount for the new L code, total reimbursement for Power Knee will not be affected by this change.

2. Three Codes Instead of Five. Once the new L code takes effect you will only need to use 3 L codes to describe Power Knee: L5856, L5859, and LXXXX. We expect Medicare will add the new code to the HCPCS fee in the next few months. Stay alert for updates from Össur R&R so that you learn when the new code takes effect and can update your EMR accordingly.

We will keep you apprised of additional information regarding this and other new L-codes as information becomes available.