Retired - Correct Coding – PRO-FLEX® Prosthetic Foot (Össur)

DME MAC Joint Publication

There have been recent inquiries to the DME MACs regarding the correct HCPCS coding to be used for Medicare billing of the Össur PRO-FLEX® prosthetic foot.  The company describes the product thusly in the “Instructions for Use”:

PRO-FLEX® is a prosthetic foot with anatomically located ankle pivot joint.  Two supporting joints connect flexible carbon blades and act together with the main joint to provide progressive energy storing during the whole stance phase and a powerful push-off in the end of stance.

Based upon a review of publicly available information from the manufacturer and other sources, the correct HCPCS code for Medicare billing of the PRO-FLEX® prosthetic foot is:

L5979 (ALL LOWER EXTREMITY PROSTHESIS, MULTI-AXIAL ANKLE, DYNAMIC RESPONSE FOOT, ONE PIECE SYSTEM)

This code is considered as all-inclusive for the PRO-FLEX® prosthetic foot.  Use of other HCPCS code to bill Medicare for any additional features and functions will be denied as incorrect coding.

Refer to the Lower Limb Prostheses LCD, Related Policy Article, and Standard Documentation Article for additional information about coverage, coding, and documentation for prosthetic feet.

For questions about correct coding, contact the PDAC Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form located on the PDAC website: https://www.dmepdac.com/.