Summary & Overview
HCPCS L5810: Endoskeletal Knee-Shin Single-Axis Manual Lock
HCPCS Level II code L5810 denotes an addition to an endoskeletal knee-shin prosthetic system: a single-axis knee with a manual lock. The code is important for national prosthetics billing because it identifies a specific mechanical knee component that affects device function, clinical selection, and payer coverage decisions. Facilities and prosthetics providers use this code to document provision of a locking knee joint within an endoskeletal shank assembly.
Key payers in typical national coverage discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what L5810 represents clinically and operationally, plus an overview of payer coverage considerations. The publication highlights typical sites of service and the service type tied to this component, and it outlines what information is available versus missing in the provided input.
This summary prepares clinicians, billing staff, and policy analysts to interpret claims lines that include L5810, understand where the item is typically supplied and fitted, and identify where to seek further details on coverage criteria, coding guidance, and related codes. Data elements not supplied in the input are noted as unavailable so readers can prioritize follow-up with payers or suppliers.
Billing Code Overview
HCPCS Level II code L5810 describes an addition to an endoskeletal knee-shin prosthetic system that provides a single-axis, manual locking knee. This component is used as part of an endoskeletal prosthesis to provide knee stability through a manually engaged lock at the knee joint.
Service type: Prosthetic component provision and fitting
Typical site of service: Orthotics and prosthetics clinic, prosthetic fabrication facility, or outpatient rehabilitation/prosthetics practice
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a transtibial amputation is evaluated in a prosthetics clinic for fitting of an endoskeletal prosthetic leg. The patient presents with a transtibial residual limb that demonstrates good soft-tissue coverage and stable volume, but has limited knee control due to instability and requires a knee-shin component with a single-axis, manual lock to allow safe transfers and ambulation on level surfaces. The prosthetist reviews prior medical records, performs a residual-limb assessment, takes measurements and casts, and documents functional level, limb shape, and goals. The endoskeletal knee-shin system with a single-axis manual lock is ordered as an addition (L5810) to the existing prosthesis. Clinical workflow includes fabrication in the prosthetic lab, bench alignment, static and dynamic alignment fitting, gait training with a physical therapist, and final adjustments. Follow-up visits assess skin integrity, socket fit, and function; modifications are made as needed. Typical sites of service include outpatient prosthetics clinics, hospital-based prosthetics departments, and specialty orthotics and prosthetics facilities.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when the knee-shin addition is for the left limb |