L5781 HCPCS - ADDITION TO LOWER LIMB PROSTHESIS, VACUUM PUMP, RESIDUAL LIMB VOLUME MANAGEMENT AND MOISTURE EVACUATION SYSTEM

Code Information

HCPCS Code: L5781
Sequence Number: 0010
Short Description: Lower limb pros vacuum pump
Long Description: Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system
Date Added: 1/1/2003
Action Code: N - No maintenance for this code
Action Effective Date: 1/1/2003
Classification: Orthotic/Prosthetic Procedures
Coding System: HCPCS

Pricing Indicator Code:
- 38 - Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)
Multiple Pricing Indicator Code: A - Not applicable as HCPCS priced under one methodology
Coverage Issues Manual Reference Section Number:
N/A
Medicare Carriers Manual Reference Section Number:
N/A
Coverage Code: C - Carrier judgment

Field Name	Field Value
Healthcare Common Procedure Coding System Code	L5781
HCPCS Sequence Number	0010
HCPCS Record Identification Code	3 - First line of procedure record also contains detail information in positions 92-275
HCPCS Long Description	Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system
HCPCS Short Description	Lower limb pros vacuum pump
HCPCS Pricing Indicator Code 1	38 - Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)
HCPCS Multiple Pricing Indicator Code	A - Not applicable as HCPCS priced under one methodology
HCPCS Coverage Code	C - Carrier judgment
HCPCS Berenson-Eggers Type Of Service Code	D1F - Prosthetic/Orthotic devices
HCPCS Type Of Service Code 1	P - Lump sum purchase of DME, prosthetics, orthotics
HCPCS Anesthesia Base Unit Quantity	0
HCPCS Code Added Date	1/1/2003
HCPCS Action Effective Date	1/1/2003
HCPCS Action Code	N - No maintenance for this code