Summary & Overview
HCPCS L5814: Endoskeletal Knee-Shin Addition, Polycentric Hydraulic Swing/Lock
HCPCS Level II code L5814 identifies an addition to an endoskeletal knee-shin prosthetic system with a polycentric joint, hydraulic swing phase control, and a mechanical stance phase lock. The code captures a specific prosthetic component designed to manage knee motion during gait—combining fluid-controlled swing dynamics with a secure mechanical lock for stance stability. Nationally, this code is relevant for coverage determinations, durable medical equipment (DME) billing, and clinical decisions about prosthetic component selection for lower-limb amputees.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what the code represents, typical sites of service, and the clinical context for use. The publication outlines common billing modifiers and payer considerations, summarizes reimbursement benchmarks where available, and highlights policy and coverage themes that affect access to advanced knee-shin prosthetic components. This summary is intended to help billing staff, prosthetists, and policy analysts understand coding implications, typical clinical applications, and areas where payer policy language commonly influences authorization and reimbursement.
Billing Code Overview
HCPCS Level II code L5814 describes an addition to an endoskeletal knee-shin prosthetic system featuring a polycentric joint, hydraulic swing phase control, and a mechanical stance phase lock. This device component is used to provide controlled knee motion during swing phase while offering a mechanical lock during stance for stability.
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Service type: Prosthetic component addition — endoskeletal knee-shin system with advanced swing and stance phase control
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Typical site of service: Durable medical equipment/supplies (DME) settings, prosthetics clinics, outpatient orthotics and prosthetics (O&P) facilities, and institutional DME suppliers
Clinical & Coding Specifications
Clinical Context
A 58-year-old male transtibial amputee with a long-standing above-knee weakness on the contralateral limb presents for prosthetic knee component upgrade to improve gait stability and energy efficiency. The treating prosthetist and orthotist team evaluate the residual limb, alignment, and functional K-level. The patient demonstrates adequate limb volume, healed residual limb tissues, and ambulates household to community distances but exhibits knee instability during swing and inconsistent stance control on uneven surfaces. After multidisciplinary review, the team prescribes an endoskeletal polycentric knee-shin system with hydraulic swing phase control and a mechanical stance phase lock to address controlled knee flexion during swing and reliable stance stability.
The clinical workflow includes: referral from a physical medicine and rehabilitation physician; pre-prosthetic assessment by a certified prosthetist; measurement and casting or scanning of the residual limb; fabrication and bench alignment of the endoskeletal knee-shin assembly; component fitting and dynamic alignment trial; gait training with a physical therapist; final adjustments and patient education on donning, maintenance, and precautions; and final delivery with documentation of functional outcome and justification for the specific knee features. Billing for the addition of the knee-shin system uses HCPCS code L5814 with applicable modifiers to indicate laterality, prosthesis type, or payer-specific reporting requirements.
Coding Specifications
| Modifier | Description | When to Use |
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