Summary & Overview
HCPCS L5987: Lower Extremity Prosthesis, Shank-Foot with Vertical Loading Pylon
HCPCS Level II code L5987 denotes an all lower extremity prosthesis comprising a shank-foot system with a vertical loading pylon. This durable medical equipment code identifies a component-level prosthetic device used to restore mobility and load-bearing function for individuals with lower limb amputation. Nationally, such prosthetic component codes matter for access to mobility aids, standardized billing across settings, and clarity in coverage policy for complex prosthetic technologies.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for L5987, typical sites of service, and what to expect in payer coverage practice. The publication outlines benchmark elements and policy-related considerations relevant to prosthetic device reimbursement and utilization, clarifying areas where payer guidance or documentation expectations commonly apply.
This summary provides clinicians, billing staff, and policy analysts with the essential code meaning, service implications, and the scope of payers examined. Data not available in the input is explicitly noted where applicable.
Billing Code Overview
HCPCS Level II code L5987 describes an all lower extremity prosthesis, shank foot system with vertical loading pylon. This code represents a prosthetic device designed to replace a lower limb, incorporating a shank-foot assembly and a vertical loading pylon intended to absorb and transmit loads during ambulation.
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Service Type: Prosthetic device provision and fitting for lower extremity amputation
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Typical Site of Service: Prosthetics clinic, outpatient orthotics and prosthetics facility, or hospital outpatient department
The description covers the component-level prosthesis rather than a surgical procedure or evaluation. Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with unilateral transtibial amputation due to peripheral arterial disease presents for prosthetic fitting. The prosthetist and multidisciplinary team evaluate gait, limb volume, skin integrity, and activity level. After casting or digital scan of the residual limb and alignment assessment, the patient is fitted with an all lower extremity prosthesis shank foot system featuring a vertical loading pylon (L5987) to provide shock absorption and improved energy return for weight-bearing and ambulation. The clinical workflow includes: initial evaluation and measurement, ordering of the L5987 device, fabrication and assembly by the prosthetic lab, delivery and alignment adjustments, a follow-up visit for gait training with physical therapy, and periodic maintenance or adjustments as the residual limb volume changes.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when the prosthesis is for the left lower extremity |
RT | Right side |