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    OpenPayerBilling CodesProsthetic ProceduresHCPCS hcpcs-l5828-endoskeletal-knee-shin-single-axis-fluid-control
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    HCPCS Level II L5828: Endoskeletal Knee-Shin System, Fluid Swing/Stance

    HCPCS Level II code L5828 describes the addition of an endoskeletal knee-shin prosthetic component with a single axis and fluid-based swing and stance phase control, representing a lower-extremity orthotic/prosthetic device used as a modular knee joint assembly for transfemoral or knee-disarticulation prostheses; service type: prosthetic component provision and fitting; typical site of service: prosthetics/orthotics clinic or outpatient prosthetic fitting 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 54-year-old male transtibial amputee with a healed residual limb and chronic knee instability from a previous traumatic amputation is evaluated for prosthetic component upgrades. The multidisciplinary limb team (physiatrist, prosthetist, and physical therapist) determines the patient would benefit from an endoskeletal knee-shin system providing single-axis control with fluid swing and stance phase modulation to improve gait symmetry and safety. The prosthetist orders the component, documents baseline gait assessment, and obtains prior authorization from Medicare or the patients commercial payer. On delivery day in the outpatient prosthetics clinic (or ambulatory surgery/prosthetics lab if fitting requires sterile conditions), the prosthetist fits the L5828 knee-shin unit into the patients existing prosthesis, aligns the knee axis, and performs dynamic tuning during gait training. Follow-up visits with the prosthetist and physical therapist occur at 1 week, 4 weeks, and as clinically indicated to adjust hydraulic resistance and stance control settings. Billing uses the HCPCS Level II code L5828 with applicable modifiers for laterality, supplier type, or unusual circumstances; supporting clinical documentation includes residual limb status, functional mobility goals, gait assessment, and payer authorization details.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    97760Orthotic(s)/prosthetic(s) management and training, initial encounter; each 15 minutesUsed by physical therapists or prosthetists for gait training and device use instruction after fitting the L5828 component
    97761Prosthetic training, subsequent encounter, each 15 minutesUsed for follow-up prosthetic training sessions after initial fitting and tuning
    20550Injection(s); single tendon sheath, or ligament, or ganglion cyst (eg, trigger point) — (example procedure)Occasionally used if soft-tissue injections are required to manage residual limb pain prior to definitive prosthetic fitting
    99070Supplies and materials (except spectacles), provided by the physician or supplier over and above those usually included with the office visit or other servicesUsed to bill nonstandard fitting materials, pads, or liners associated with customizing the L5828 during fitting
    99456Work-related or medical disability examination services for work disability evaluationMay be used when a formal documentation of functional level is required for workers' compensation or disability determinations related to prosthetic provision

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    33Modifier 33 was created by the American Medical Association in response to the Affordable Care Act to identify services provided for preventive intent. It is appended to CPT/HCPCS codes that could be…- Use modifier -33 when a CPT/HCPCS service that can be billed as either preventive or diagnostic/treatment is provided with preventive intent and aligns with USPSTF A or B recommendations or other…
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    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    2084P0800X
    208D00000X
    207RC0000X
    193200000X
    364SP0200X
    2472E0500X
    246X00000X
    235Z00000X

    Related ICD-10-CM Codes

    24 rows

    ICD-10-CM CodeDescription
    G82.20Paraplegia, unspecified
    G83.4Cauda equina syndrome
    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
    M17.9Osteoarthritis of knee, unspecified
    M23.91Unspecified internal derangement of right knee
    M25.561Pain in right knee
    M25.562Pain in left knee

    Showing 1–10 of 24

    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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