Summary & Overview
HCPCS L5827: Endoskeletal Knee-Shin, Electromechanical Swing and Stance Control
HCPCS Level II code L5827 represents an endoskeletal knee-shin prosthetic system with a single-axis design and electromechanical control of swing and stance phases, optionally including shock absorption and stance extension damping. Nationally, advanced prosthetic knees with electromechanical control are important for improving mobility, stability, and gait symmetry in lower-limb amputees and can influence clinical outcomes, rehabilitation needs, and durable medical equipment policy.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise overview of coverage and billing considerations across major national payers and Medicare, outlines typical sites of service, and summarizes how this device fits into clinical prosthetic care pathways.
Readers will learn what L5827 covers clinically, where these services are typically delivered, and which national payers are relevant for coverage discussions. The report also highlights benchmarking topics and policy updates relevant to advanced prosthetic devices, and offers context on clinical use in rehabilitation and prosthetic fitting workflows. Data not available in the input is indicated where applicable.
Billing Code Overview
HCPCS Level II code L5827 describes an endoskeletal knee-shin prosthetic system with a single-axis, electromechanical swing and stance phase control, and may include shock absorption and stance extension damping. This device is used as a prosthetic knee-shin component to provide powered or controlled movement during both swing and stance phases for lower-limb amputees.
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Service type: Prosthetic knee-shin component, advanced electromechanical orthotic/prosthetic device
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Typical site of service: Orthotics and prosthetics clinic, outpatient rehabilitation facility, prosthetic fitting center, or hospital outpatient setting
Clinical & Coding Specifications
Clinical Context
A 56-year-old patient with a transtibial (below-knee) amputation presents for provision of an advanced prosthetic knee-shin component. The patient demonstrates functional ambulation goals requiring a microprocessor-controlled, single-axis endoskeletal knee-shin system that provides electromechanical swing and stance phase control with optional shock absorption and stance extension damping. The multidisciplinary workflow includes: prosthetist assessment for limb volume and socket compatibility; physical therapy evaluation of gait, balance, and K-level classification; ordering and authorization by the treating physician; fabrication and alignment by the prosthetist; device tuning and training in clinic; and follow-up visits for gait optimization and component maintenance. Typical encounters occur in an outpatient prosthetics clinic, specialty orthotics and prosthetics facility, or rehabilitation center. Documentation includes medical necessity, K-level justification, functional mobility assessments, trial outcomes, device specifications, and proof of delivery and patient training.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier; standard reporting | Use as the default when no special circumstances apply |
22 |