Summary & Overview
HCPCS L5312: Knee Disarticulation Prosthesis with Single-Axis Knee
HCPCS Level II code L5312 denotes a complete knee-disarticulation prosthetic assembly including a molded socket, single-axis knee joint, pylon, SACH foot, and endoskeletal components. This code is relevant nationally for prosthetic service lines managing post-amputation rehabilitation and device provision, reflecting a common modular configuration for patients with through-knee or knee-disarticulation amputations.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides readers with a concise overview of clinical context for this prosthesis type, typical sites of service (outpatient prosthetics clinics and orthotics & prosthetics facilities), and payer coverage considerations. Readers will find benchmarks and practical billing context: usual service composition, common payer coverage patterns, and coding implications for prosthetic device provisioning. The content also summarizes how this code fits into prosthetic device categorization and what clinical teams and billing staff should note when documenting service components.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line specifics. The piece is intended to support national stakeholders — clinicians, prosthetists, case managers, and revenue-cycle staff — needing a clear reference for HCPCS Level II code L5312.
Billing Code Overview
HCPCS Level II code L5312 describes a knee disarticulation (or through knee) prosthetic assembly consisting of a molded socket, single axis knee, pylon, SACH foot, and an endoskeletal system. This represents a lower-limb prosthesis built for patients following a knee disarticulation amputation or through-knee procedure.
Service Type: Prosthetic lower-limb device fabrication and provision
Typical Site of Service: Outpatient prosthetics clinic or orthotics & prosthetics facility
Clinical & Coding Specifications
Clinical Context
A 58-year-old male with a history of peripheral arterial disease and chronic nonhealing below-knee ischemic wounds presents with progressive infection and pain unresponsive to revascularization and debridement. After multidisciplinary evaluation (vascular surgery, physical medicine & rehabilitation, prosthetics), a decision is made for a knee disarticulation amputation. The prosthetic prescription is for a molded socket with a single-axis knee joint, pylon, SACH foot, and an endoskeletal system to provide durable weight-bearing, limb length preservation, and improved prosthetic fitting.
Perioperative workflow: preoperative assessment and documentation of medical necessity, surgical procedure (knee disarticulation) performed in the operating room, postoperative inpatient recovery or short-stay observation as indicated, wound healing and stump maturation follow-up, initial prosthetic fitting by a certified prosthetist, iterative socket adjustments, gait training with a physical therapist, and follow-up visits for prosthesis alignment and component replacement as needed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the clinician’s professional service related to the prosthetic fitting or evaluation separate from the device supply if applicable |