License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

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POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

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Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
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June 25, 2026

Functional Level Modifiers for Lower Limb Prostheses – New Codes Added

The Lower Limb Prostheses Policy Article (A52496) requires that any claim for a prosthetic hip, knee, ankle, or foot must include a functional level modifier (i.e., K0, K1, K2, K3, or K4). This applies to all of the HCPCS codes listed below:

L5610, L5611, L5613, L5614, L5615, L5616, L5710, L5711, L5712, L5714, L5716, L5718, L5722, L5724, L5726, L5728, L5780, L5810, L5811, L5812, L5814, L5816, L5818, L5822, L5824, L5826, L5827, L5828, L5830, L5840, L5841, L5845, L5848, L5850, L5855, L5856, L5857, L5858, L5859, L5925, L5926, L5930, L5961, L5968, L5970, L5971, L5972, L5973, L5974, L5975, L5976, L5978, L5979, L5980, L5981, L5982, L5984, L5985, L5986, L5987, and L5988.

For dates of service on or after August 1, 2026, CGS will add new edits that will automatically reject claims for the following codes if they do not include a functional level modifier:

L5845
L5850
L5855
L5925
L5926
L5988

To avoid claim denials, you should update your system now so that all the codes listed above are billed with the correct K‑level modifier. Although the new edits won’t go into effect until August 1, you can begin submitting the modifiers right away to make sure your system is ready.

All the other codes listed above already have edits in place that require a K‑level modifier.

If a claim is submitted without the required K-level modifier, it will be rejected for missing information. You can resubmit the claim with the correct modifier.

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

AMA Disclaimer of Warranties and Liabilities.

CMS Disclaimer

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

Functional Level Modifiers for Lower Limb Prostheses – New Codes Added

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