Lower Limb Prosthetic Required Prior Authorization
CMS added the following 6 HCPCS codes for LLPs to the required prior authorization list: L5856, L5857, L5858, L5973, L5980, and L5987 (functional level 3 or above).
As of December 1, 2020, prior authorization of these codes is required for all states and territories.
The fastest, easiest way to submit prior authorization requests is through the DME myCGS portal.
- If you are not yet registered for myCGS, get started with the myCGS Registration and Account Management Guide.
- If you are already registered for myCGS, read the "Prior Authorization" section in the myCGS User Manual.
Please allow three business days after submission for requests to appear in myCGS. Aside from the myCGS web portal, suppliers can submit PA requests via mailing address, fax, and esMD using the Prior Authorization (PA) Submission Form
Resources
- CGS issued a new prior authorization coversheet
. Begin using the new coversheet as soon as possible.
- 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: 11.13.23