Medicare AdvantageBilling CodesHigh impact
MA05.024l, Lower Limb Prostheses
Independence Blue Cross·Orthopedics, Physical Therapy, PM&R (Physical Medicine & Rehab)·Medical Policy
Effective date
Jun 29, 2026
We identified it
Jun 30, 2026
Summary
Independence Blue Cross updated MA05.024l to clarify that HCPCS code L5999 (Lower Extremity Prostheses, Not Otherwise Specified) cannot be used for billing socket features or functions that are included in other L-codes, as this constitutes incorrect coding and unbundling. L5999 has been added to the 'Not Eligible for Separate Reimbursement' section effective immediately.
Action Required
By June 29, 2026: Billing team must update billing system edits and staff training to prohibit use of HCPCS code L5999 for any socket features or functions that are designated by other L-codes. Remove L5999 from claim submission protocols for lower limb prosthesis billing. Implement system-level blocking or hard-stop edits to prevent L5999 from being billed in conjunction with socket or addition codes on the same claim. Review all pending and in-process claims submitted after this date to ensure L5999 is not being used for bundled services. Notify prosthetics suppliers and providers that L5999 use for socket components will result in claim denials for non-compliance with Medicare Advantage coverage policy.