The DME MACs recently released some revisions to the Lower Limb Prostheses Policy Article. The majority of the revisions were clerical in nature, however there was one change which may impact how you submit your claims.
The revised Policy Article now requires you to include K-level modifiers (K0-K4) on all claims with a date of service on or after August 1, 2026, for the following codes:
- L5827- Endoskeletal knee-shin system, single axis, electromechanical swing and stance phase control, with or without shock absorption and stance extension damping
- L5845- Addition, endoskeletal, knee-shin system, stance flexion feature, adjustable
- L5850- Addition, endoskeletal system, above knee or hip disarticulation, knee extension assist
- L5855- Addition, endoskeletal system, hip disarticulation, mechanical hip extension assist
- L5925- Addition, endoskeletal system, above knee, knee disarticulation or hip disarticulation, manual lock
- L5926- Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type
- L5968- Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature
- L5988 – Addition to lower limb prosthesis, vertical shock reducing pylon
If a K-level modifier is not included on claim lines for the above listed codes, the claim line will be rejected as missing information.
It is key to stress that these codes don’t require a specific K-level modifier for coverage, but they must include a K0-K4 modifier for claim submission purposes. For example, if you have a K2 ambulator, then you would add the K2 to modifier to the above codes, and if you have a K3 ambulator then you would add the K3 to modifier to the above codes.
Questions? Contact Joe McTernan at jmcternan@AOPAnet.org or Devon Bernard at dbernard@AOPAnet.org.