L5992 Low prosth foot shell replAll lower extremity prosthesis, foot shell for modular foot/non-solid ankle cushion heel (sach) replacement only
3 of 3 payer prior-auth lists that name L5992 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue).
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross Blue Shield of Arizona (AZ Blue) | AZ Blue-administered Medicare Advantage (M2K) | AZ | prior auth required | Sep 1, 2026 | AZ Blue Medicare Advantage Prior Authorization Requirements Code List (Effective 09/01/2026) | |
| Blue Cross Blue Shield of Arizona (AZ Blue) | Standard PA code list (most commercial plans) | AZ | prior auth required | Sep 1, 2026 | AZ Blue Standard Prior Authorization Requirements Code List (09/01/2026) | |
| Blue Cross Blue Shield of Arizona (AZ Blue) | State of Arizona employee group (SYD, S3Z) | AZ | prior auth required | Sep 1, 2026 | State of Arizona Group Prior Authorization Requirements Code List (09/01/2026) |
L5992 appears in 16 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, 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 | Oct 9, 2026 | payer document |
| Anthem | Lower Limb Prosthesis (CG-OR-PR-12) Repair/Replacements | covered if criteria are met | Aug 13, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Prosthetics (L.1.04.401) | covered if criteria are met | payer document | |
| Blue Cross Blue Shield of Massachusetts | Microprocessor- controlled prostheses for the lower limb (133) | unproven / investigational | 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 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 MS, OH.
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.