L5430 Postop dsg ak ea add cast chImmediate post surgical or early fitting, application of initial rigid dressing, incl. fitting, alignment and supension, 'ak' or knee disarticulation, each additional cast change and realignment
3 of 3 payer prior-auth lists that name L5430 require prior authorization or set conditions: Blue Shield of California Promise Health Plan, Medicare, Rocky Mountain Health Plans.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Shield of California Promise Health Plan | Promise Health Plan Medi-Cal | CA | prior auth required | Sep 1, 2026 | Medi-Cal Prior Authorization List | |
| Medicare | DMEPOS Master List (items potentially subject to PA) | All | prior auth under conditions | On the Master List; PA only if CMS selects it for the Required List | Jul 30, 2026 | Master List of DMEPOS Items Potentially Subject to Face-to-Face Encounter and Written Order Prior to Delivery and/or Prior Authorization Requirements |
| Rocky Mountain Health Plans | Rocky Mountain Medicare Advantage D-SNP | CO | prior auth required | Feb 1, 2025 | Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025 |
L5430 appears in 17 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Shield of California, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Lower Limb Prostheses (0578) | covered if criteria are met (range L5000-L5782) | Oct 9, 2026 | payer document |
| Anthem | Lower Limb Prosthesis (CG-OR-PR-12) | covered if criteria are met (range L5400-L5460) | Aug 13, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Prosthetics (L.1.04.401) | covered if criteria are met | payer document | |
| Blue Shield of California | BSC1.01 | Lower Limb Prostheses | listed, no stance | payer document | |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Lower-Limb Prosthetics, Including Microprocessor-Controlled Prosthetics (DME104.012) HCPCS Codes L2221, L5000, L5010, L5020, L5050, L5060, L5100, L5105, L5150, L5160, | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Lower Extremity Prosthetics (2026T0645N) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Lower Extremity Prosthetics (CS361.H) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Lower Extremity Prosthetics (for Idaho Only) (CS361ID.F) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Lower Extremity Prosthetics (for Kansas Only) (CS361KS.05) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Lower Extremity Prosthetics (for Kentucky Only) (CS361KY.07) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Lower Extremity Prosthetics (for Nebraska Only) (CS361NE.G) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Lower Extremity Prosthetics (for New Jersey Only) (CS361NJ.H) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Lower Extremity Prosthetics (for New Mexico Only) (CS361NM.F) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Lower Extremity Prosthetics (for North Carolina Only) (CSNCT0361.05) | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Lower Extremity Prosthetics (for Ohio Only) (CS361OH.F) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Lower Extremity Prosthetics (for Pennsylvania Only) (CS361PA.G) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Lower Extremity Prosthetics (for Tennessee Only) (CS361TN.H) | listed, no stance | Sep 1, 2026 | payer document |
Prior authorization required or conditional in MA, NY, OH, VA, WV.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.