Adjustable Pylon Reimbursement

Now being reimbursed by Medicare and commercial insurances:
2015-2016 Manufacturer’s Suggested Retail Pricing (MSRP): $550.00.
L5999: Addition to lower extremity prosthetics; User adjustable height pylon, adult or pediatric, AK or BK.

Reimbursement L-code:
L5999 – ADDITION, LOWER LIMB PROSTHESIS, VERTICAL ADJUSTING PYLON FEATURE, ADULT OR PEDIATRIC

OPIE Justification:
The adjustable pylon is a necessary component to allow telescoping height adjustment to the prosthesis. This allows the wearer to eliminate leg length discrepancies during acute and long-term prosthetic treatments as a result of residual limb changes. One revolution allows a 1/16” adjustment either increasing or decreasing the height.

Medicare 80 Character Description for Claim Submission:
“Addt to Lower Prosthesis, Vertical Adjusting Pylon Feature, Adult or Pediatric”

Full Descriptor:
The Vertical Adjusting Pylon Feature allows therapeutic benefit beyond the standard tube and clamp pylon and in addition to the alignable endoskeletal systems. The patent pending design offers the wearer capability for telescoping height adjustments to accommodate limb volumetric changes, thereby improving fit and function by allowing necessary adjustments in prosthesis height. It is also useful for wearers who desire to wear a variety of shoes on their sound side that may have variable heel height. The availability of unlimited telescoping adjustability of the vertical adjusting pylon limits leg length discrepancy problems common to lower limb prosthetic wearers and thereby decreases their incidence of lower back pain. With clinician oversight and training the user can also make adjustments to the pylon height allowing proper fit and function regardless of the shoe they select to wear on a particular day. The same prosthesis may accommodate a sound side ladies dress heel, an athletic shoe, or a sandal without sacrificing proper fit.

Similar to L5910 ADDITION, ENDOSKELETAL SYSTEM, BELOW KNEE, ALIGNABLE SYSTEM and L5920 ADDITION, ENDOSKELETAL SYSTEM, ABOVE KNEE OR HIP DISARTICULATION, ALIGNABLE SYSTEM, except the “alignability” described here refers to the coronal and sagittal planes due to the endoskeletal nature of the prosthesis. The function of the alignable endoskeletal addition is to allow adjustments/changes to the side-to-side planes after provision of the prosthesis. The Vertical Adjusting Pylon attends to adjustment in the axial (height) plane and therefore is not alignment.