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    v1.0.31
    OpenPayerBilling CodesProsthetic ProceduresHCPCS hcpcs-l5728-exoskeletal-knee-shin-fluid-swing-stance-control
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    HCPCS Level II L5728: Exoskeletal Knee-Shin, Single Axis, Fluid Control

    HCPCS Level II code L5728 describes an addition of an exoskeletal knee-shin system, single axis, with fluid swing and stance phase control, a prosthetic component added to lower-limb orthoses or exoskeletal devices to provide controlled swing and stance dynamics; service type is prosthetic/orthotic component fitting and addition, and the typical site of service is outpatient orthotics/prosthetics clinic or prosthetic supplier facility.

    For related coverage guidance, see recent payer policy updates: Speech Therapy for Autism Disorders - Medical Policy, Physical Performance Test or Measurement, Sensory Integration Therapy and Auditory Integration Training.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 62-year-old patient with post-polio residual limb weakness and knee instability presents to an orthotics clinic for evaluation of gait dysfunction and frequent falls. The clinician assesses for an exoskeletal knee-shin orthosis with single-axis, fluid swing and stance phase control to provide dynamic stability during stance and smoother, controlled knee flexion during swing. The clinical workflow includes: a comprehensive history and physical exam focused on strength, range of motion, skin integrity, and functional mobility; gait analysis (observational and/or instrumented) to document swing-phase control deficits; measurement and casting of the residual limb for a custom exoskeletal unit; trial fitting and alignment of the single-axis fluid-controlled knee joint; patient education on donning, doffing, and fall prevention; and follow-up visits for break‑in adjustments, durability checks, and functional outcome assessment. The device is coded as L5728 for the addition of an exoskeletal knee‑shin system with single-axis, fluid swing and stance phase control, fitted and fabricated by an orthotist or prosthetist in an outpatient orthotics/prosthetics clinic, rehabilitation facility, or hospital outpatient department.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    97760Orthotic management and training, initial encounter, per deviceUsed for initial training and education in donning, doffing, skin checks, and functional use of the exoskeletal knee‑shin device.

    | 97763 | Orthotic/prosthetic management and training, subsequent encounter | Used for follow-up training visits, adjustments, and reassessment after initial fitting of L5728. |

    | 99456 | Work-related or medical-legal evaluation, impaired body function, not otherwise specified | May be used when independent medical evaluation for work capacity or device necessity is required; use per payer rules. |

    | 95831 | Electromyography, needle; one extremity with examination of two muscles | Used when electrodiagnostic testing is performed to document neurologic deficits contributing to gait dysfunction prior to orthotic provision. |

    | 97162 | Physical therapy evaluation, moderate complexity | Used by physical therapists evaluating gait, balance, and functional deficits prior to orthotic prescription and training. |

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    225100000X
    193200000X
    367A00000X
    163WC1500X
    163WP0807X
    2084B0040X
    163WM1400X
    207QP0002X

    Related ICD-10-CM Codes

    25 rows

    ICD-10-CM CodeDescription
    G71.3Mitochondrial myopathy, not elsewhere classified
    G82.20Paraplegia, unspecified
    G82.21Paraplegia, complete
    M16.11Unilateral primary osteoarthritis, right hip
    M16.12Unilateral primary osteoarthritis, left hip
    M17.0Bilateral primary osteoarthritis of knee
    M17.11Unilateral primary osteoarthritis, right knee
    M17.12Unilateral primary osteoarthritis, left knee
    M17.2Bilateral post-traumatic osteoarthritis of knee
    M17.5Other unilateral secondary osteoarthritis of knee

    Showing 1–10 of 25

    Related Payer Policy Updates

    Specialty: Physical Medicine, Rehab & Therapies1 / 2

    10 rows

    PolicyPayerEffective Date
    Speech Therapy for Autism Disorders - Medical PolicyHealth-New-England2026-12-01
    Physical Performance Test or MeasurementCigna2026-11-15
    Sensory Integration Therapy and Auditory Integration TrainingColorado Rocky Mountain Health Plans2026-11-01
    Skilled Nursing and Skilled Rehabilitation Services (Outpatient)Anthem2026-10-01
    Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for New Mexico Only)UnitedHealthcare2026-10-01
    Physical Therapy/Medicine Corporate Medical Policybcbsvermont2026-10-01
    Cognitive Rehabilitation Corporate Medical Policybcbsvermont2026-10-01
    Speech Language Pathology/Therapy Services Corporate Medical Policybcbsvermont2026-10-01
    Occupational Therapy Corporate Medical Policybcbsvermont2026-10-01
    Biomagnetic TherapyConnectiCare2026-09-11

    Related Codes

    HCPCS-L5000-PARTIAL-FOOT-SHOE-INSERT-LONGITUDINAL-ARCH-TOE-FILLER

    HCPCS Level II L5000: Partial Foot Shoe Insert with Longitudinal Arch, Toe Filler

    HCPCS-L5010-PARTIAL-FOOT-MOLDED-SOCKET-ANKLE-HEIGHT-TOE-FILLER

    HCPCS L5010: Partial Foot Molded Socket, Ankle Height, With Toe Filler

    HCPCS-L5020-PARTIAL-FOOT-MOLDED-SOCKET-TIBIAL-TUBERCLE-TOE-FILLER

    HCPCS L5020: Partial Foot Molded Socket with Toe Filler

    HCPCS-L5050-ANKLE-SYMES-MOLDED-SOCKET-SACH-FOOT

    HCPCS L5050: Ankle/Symes Molded Socket with SACH Foot

    HCPCS-L5060-ANKLE-SYMES-METAL-FRAME-MOLDED-LEATHER-SOCKET-ARTICULATED-ANKLE-FOOT

    HCPCS L5060: Ankle/Symes Metal Frame with Molded Leather Socket

    HCPCS-L5100-BELOW-KNEE-MOLDED-SOCKET-SHIN-SACH-FOOT

    HCPCS Level II L5100: Below-Knee Molded Socket with Shin and SACH Foot

    HCPCS-L5105-BELOW-KNEE-PLASTIC-SOCKET-SACH-FOOT

    HCPCS L5105: Below-Knee Plastic Socket Prosthesis with SACH Foot

    HCPCS-L5150-KNEE-DISARTICULATION-MOLDED-SOCKET-EXTERNAL-KNEE-SACH-FOOT

    HCPCS L5150: Knee Disarticulation Molded Socket with External Knee and SACH Foot

    HCPCS-L5160-KNEE-DISARTICULATION-MOLDED-SOCKET-BENT-KNEE-SACH-FOOT

    HCPCS Level II L5160: Knee Disarticulation Molded Socket, Bent Knee Configuration

    HCPCS-L5200-ABOVE-KNEE-MOLDED-SOCKET-SINGLE-AXIS-KNEE-SACH-FOOT

    HCPCS Level II L5200: Above-knee Prosthesis with Molded Socket and Single-axis Knee

    Showing 1–10 of 472

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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