Lower Limb Prostheses - Final LCD and Response to Comments (RTC) Article Published

Joint DME MAC Publication
Posted July 18, 2024

On July 18, 2024, the DME MACs published the following final Local Coverage Determination (LCD) and LCD-related Policy Article (PA):

  • Lower Limb Prostheses LCD (L33787) and LCD-related PA (A52496)

The LCD incorporates finalized revisions, as a result of the LCD reconsideration process and written comments received during the comment period for the proposed LCD. The final LCD modifies the coverage criteria for microprocessor-controlled prosthetic knees (MPKs), to include coverage for Medicare Functional Classification Level (MFCL) 2 beneficiaries with lower limb amputations who require a prosthetic knee; modifies the coverage criteria for prosthetic feet in order to allow coverage of a compatible foot when coverage criteria for an MPK are met; adds GA, GY, GZ, and KX modifiers to the Coding Information section of the LCD; and adds HCPCS code L5841 to the coverage criteria for fluid and pneumatic knees.

The posting of the final LCD marks the beginning of the 45-day notice period. The final LCD goes into effect for claims with dates of service on or after September 1, 2024.

Along with the final LCD and LCD-related PA, the DME MACs published a Response to Comments (RTC) Article which addresses the written comments received during the comment period. The RTC Article is as follows:

  • Response to Comments: Lower Limb Prostheses LCD DL33787 (A59857)

Interested stakeholders may find the RTC document by searching for the article number in the Medicare Coverage Database. The RTC document is also located in the Associated Documents section of the LCD.

Please refer to each DME MAC website for additional information about policy development and access to the final LCD.

Last Updated Jul 18 , 2024