Lower Limb Prosthetic Required Prior Authorization
CMS has added the following six HCPCS codes for Lower Limb Prosthetics (LLP) to the Required Prior Authorization list: L5856, L5857, L5858, L5973, L5980, and L5987 (functional level 3 or above). As of November 17, 2020, prior authorization of these codes is required for all states and territories.
Fill out the Prior Authorization (PA) Submission Form and submit via the myCGS web portal. Mail and fax options are listed on the form and available if needed.
Prior Authorization (PA) Submission Form
Resources
- Reasons for Non-Affirmed Prior Authorization for Lower Limb Prostheses
- Prosthetic Feet and Additions to Lower Limb Extremity Prostheses – Correct Coding and Coding Verification Review Requirement
- Lower Limb Prosthetics (LLP) Prior Authorization – What Suppliers Need to Know
- LLP Documentation Checklist
- JB Dear Physician Letter
- JB Local Coverage Determinations (LCDs)
- Required Prior Authorization for Certain DMEPOS Items to Resume
- Prior Authorization HCPCS Look-Up Tool
CMS Resources
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetic, Orthotics, Supplies (DMEPOS) Items
- Prior Authorization Operational Guide
- Open Door Forum Slides for LLPs 03-11-2020
Updated: 02.10.21