Summary & Overview
HCPCS L5220: Above-Knee Short Prosthesis (Stubbie) with Articulated Ankle/Foot
HCPCS Level II code L5220 represents a short above-knee prosthesis without a knee joint (a "stubbie") that includes an articulated ankle/foot and is dynamically aligned. This prosthetic configuration is used for transfemoral amputees who require a short residual limb solution where a knee joint is not indicated, offering stability and some ankle motion through integrated ankle/foot components. Nationally, accurate reporting of this code matters for clinical coordination, prosthetic device coverage determinations, and durable medical equipment billing consistency.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context and typical sites of service, as well as what to expect from payer coverage patterns and billing practices. The publication summarizes benchmarks and reimbursement context, outlines commonly seen policy considerations for coverage of specialized prosthetic devices, and provides guidance on documentation elements typically relevant to payer determinations. Data not available in the input is noted where applicable (for example, associated taxonomies, ICD-10 mappings, and related codes).
Billing Code Overview
HCPCS Level II code L5220 describes an above-knee, short prosthesis without a knee joint (commonly called a "stubbie") that includes an articulated ankle/foot and is dynamically aligned, billed per prosthesis (each). Service type: prosthetic device—lower extremity, transfemoral short prosthesis with ankle/foot componentry. Typical site of service: prosthetic and orthotic clinics, outpatient durable medical equipment suppliers, and rehabilitation or prosthetics fitting centers.
Clinical & Coding Specifications
Clinical Context
A middle-aged patient with a transfemoral (above-knee) limb loss presents to a prosthetics clinic for fitting of a short, above-knee prosthesis without a knee joint — commonly called a "stubbie" — equipped with an articulated ankle/foot and dynamically aligned. The patient may have undergone recent surgical amputation for trauma, tumor resection, or vascular disease and requires a short-length socket for mobility training in community and indoor environments. The clinical workflow includes: initial prosthetic assessment by a prosthetist and physiatrist or orthopedic surgeon; socket casting or digital scan; component selection (short pylon, appropriate foot/ankle assembly, and dynamic alignment components); fabrication and bench alignment; initial fitting and dynamic alignment adjustments during gait training with a physical therapist; follow-up visits for prosthetic tuning, socket modifications, and patient education on donning/doffing and skin care. Typical sites of service are outpatient prosthetics clinics, rehabilitation hospitals, and ambulatory surgery centers when fabrication/fitting requires on-site modifications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier used / default | Use when no additional modifier is required for the claim |
11 |