Your Blatchford team is on hand to support with your coding and reimbursement questions relating to Blatchford products, particularly in relation to the new requirements of Prior Authorization of Lower Limb Prosthetic products. Please reach out to Customer Services or your Blatchford Territory Manager for more information.
Microprocessor Feet
ElanIC | ![]() |
Microprocessor Foot | L5973 | ElanIC PDAC Approval Letter |
Elan | ![]() |
Microprocessor Foot | L5973 | Elan PDAC Approval Letter |
Hydraulic Ankles
Echelon | ![]() |
Hydraulic Ankle | L5981, L5968 | Echelon PDAC Approval Letter |
E-Carbon Feet
Elite2 | ![]() |
E-Carbon Foot | L5981 | Elite2 PDAC Approval Letter |
EliteVT | ![]() |
E-Carbon Foot | L5987, L5984 | EliteVT PDAC Approval Letter |
Elite Blade | ![]() |
E-Carbon Foot | L5980 | Elite Blade PDAC Approval Letter |
Elite BladeVT | ![]() |
E-Carbon Foot | L5987, L5984 | Elite BladeVT PDAC Approval Letter |
Javelin | ![]() |
E-Carbon Foot | L5980 | Javelin PDAC Approval Letter |
Microprocessor Knees
Orion3 | ![]() |
Microprocessor Knee | L5828, L5845, L5848, L5856 | Orion3 PDAC Approval Letter |
SmartIP | ![]() |
Microprocessor Knee | L5830, L5857 (L5845 for Stanceflex models only) |
SmartIP PDAC Approval Letter |
Other Knees
KX06 | ![]() |
Hydraulic Knee | L5840 | KX06 PDAC Approval Letter |
Limb Systems
Linx | ![]() |
Integrated Microprocessor Limb System | L5828, L5845, L5848, L5856, L5973 | Linx PDAC Approval Letter |
Liners
Silcare Breathe Locking | ![]() |
Sweat Management Liner | L5673 | Silcare Breathe Approval Letter |
Silcare Breathe Cushion | ![]() |
Sweat Management Liner | L5679 | Silcare Breathe Approval Letter |
For all Blatchford products, we have created a Suggested L Code sheet that provides our recommended L codes for each of our lower limb prosthetic products.
Play Upcoming Changes to Coding & Billing – What this means for you
Prior Authorization for Lower Limb Prosthetic codes will be implemented in two phases. Phase one will begin September 01, 2020 in one state from each Durable Medical Equipment Medicare Administrative Contractor (DME MAC) jurisdiction: California, Michigan, Pennsylvania and Texas – Cigna Government Services (CGS) will begin accepting requests for prior authorization in Michigan and Texas on August 18, 2020. Phase two will begin December 01, 2020 and expands prior authorization to all remaining states and territories.
Effective January 1, 2021 any product billed with the listed L codes must be listed on the PDAC website. The program does NOT create any new documentation requirements; it simply requires the information be submitted earlier in the claims process.
L5856: Addition to lower extremity prosthesis, endo knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type.
L5857: Addition to lower extremity prosthesis, endo knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type.
L5858: Addition to lower extremity prosthesis, endo knee-shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type.
L5973: Endo ankle foot system, microprocessor-controlled feature, dorsiflexion and/or plantar flexion control, includes power source.
L5980: All lower extremity prostheses, flex foot system
L5987: All lower extremity prosthesis, shank foot system with vertical loading pylon
DME MAC coversheet, captures all required content.
You can submit the PAR by mail, fax, electronic submission of Medical Documentation (esMD), or dedicated DME MAC provider portals. You can register with DME MAC to utilize the online portals:
Region B, Region C: www.cgsmedicare.com
Region A, Region D: www.noridianmedicare.com
DME MAC will review the PAR and respond within 10 business days. The response will include a detailed decision letter and unique tracking number (UTN), which will be needed for payment. The decision letters will be sent to the address on file with National Supplier Clearinghouse (NSC).
If your practice receives an Affirmative PAR Decision – Valid for 120 calendar days and all approved items must be delivered within those 120 days. Any delays require a new PAR.
If your practice receives a Non-Affirmative Decision-Two options
All claims for items billed to Medicare require a written order/prescription from the treating practitioner as a condition for payment. This written order/prescription is referred to as the Standard Written Order (SWO).
*Signatures must comply with the CMS signature requirements outlined in CMS Internet-Only Manuals 100-08, Program Integrity Manual (PIM), Chapter 3, Section 3.3.2.4. Signature and date stamps are not allowed. Upon request by a contractor, DMEPOS suppliers must provide documentation of the completed SWO.
A WOPD is a completed SWO that is communicated to the DMEPOS supplier before delivery of the item(s). Pursuant to Final Rule 1713 (84 Fed. Reg Vol 217)
Our US-based team is on hand if you need any information relating to the reimbursement of Blatchford lower limb prosthetic products.
Customer Services
Tel: 800.548.3534 (toll free) / 937.291.3636
Email: customerservice@blatchfordus.com
Sales
Find your Blatchford Territory Manager »
Please note: This page is for reference only. The choice of appropriate codes remains the provider’s sole responsibility to verify the accuracy of the HCPCS codes used, determine the applicability to each patient, and fulfill the medical necessity/claims documentation requirements. Blatchford assumes no responsibility or liability for the provider’s actions.