RETIRED - Correct Coding - PRO-FLEX Prosthetic Foot (Össur)

IMPORTANT: THIS DOCUMENT CONTAINS OUTDATED INFORMATION.

Content Provided on this page contains outdated information and instruction and should not be considered current. Noridian is providing this archived information for research purposes only. This archived article contains previously issued instructions that have since been updated or are no longer applicable for Medicare billing purposes.

DME MAC Joint Publication

Posted on October 5, 2017

There have been recent inquiries to the DME MACs regarding the correct HCPCS coding to be used for Medicare billing of the Össur PRO-FLEX® prosthetic foot.  The company describes the product thusly in the "Instructions for Use":

PRO-FLEX® is a prosthetic foot with anatomically located ankle pivot joint.  Two supporting joints connect flexible carbon blades and act together with the main joint to provide progressive energy storing during the whole stance phase and a powerful push-off in the end of stance.

Based upon a review of publicly available information from the manufacturer and other sources, the correct HCPCS code for Medicare billing of the PRO-FLEX® prosthetic foot is:

  • L5979 (ALL LOWER EXTREMITY PROSTHESIS, MULTI-AXIAL ANKLE, DYNAMIC RESPONSE FOOT, ONE PIECE SYSTEM)

This code is considered as all-inclusive for the PRO-FLEX® prosthetic foot.  Use of other HCPCS codes to bill Medicare for any additional features and functions will be denied as incorrect coding.

Refer to the Lower Limb Prostheses LCD, related Policy Article, and Standard Documentation Article for additional information about coverage, coding, and documentation for prosthetic feet.

For questions about correct coding, contact the Pricing Data Analysis and Coding (PDAC) Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form located on the PDAC website: https://www.dmepdac.com/.

Publication History

Date of Change Description
10/05/17 Original publication
09/03/18 Retired

 

Last Updated Dec 10 , 2023