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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that L5968, L5982, L5984, L5985, L5986, L5988, L5990 are additional features and/or functions 
that do not describe a complete prosthetic foot and may be used in combination with L5970, L5971, L5972, L5974, 
L5975, L5976, L5978, L5979, L5 980, L5981, and L5987. The use of additional feature L-codes may also 
depend on the assigned K-Level modifier (K0-K4) as referenced in the LCD. When submitting a prosthetic 
claim, the billed code for knee, foot, ankle and hip (HCPCS codes L5610, L5611, L5613, L5614, L5616, 
L5710, L5711, L5712, L5714, L5716, L5718, L5722, L5724, L5726, L5728, L5780, L5810, L5811, L5812, 
L5814, L5816, L5818, L5822, L5824, L5826, L5828, L5830, L5840, L5848, L5856, L5857, L5858, L5859, 
L5930, L5961, L5970, L5971, L5972, L5973, L5974, L5975, L5976, L5978, L5979, L5980, L5981, L5982, 
L5984, L5985, L5986, L5987) components must be submitted with modifiers K0 - K4, indicating the expected 
beneficiary functional level. This expectation of functional ability information must be clearly documented 
and retained in the prosthetist's records. The simple entry of a K modifier in those records is not sufficient. 
There must be information about the beneficiary's history and current condition which supports the designation 
of the functional level by the prosthetist. You can find this information in Medicare's Local Coverage Article 
for Lower Limb Prostheses - Policy Article (A52496). 
 
The rules say that a determination of the medical necessity for certain components/additions to the prosthesis is 
based on the beneficiary's potential functional abilities. Potential functional ability is based on the reasonable 
expectations of the prosthetist, and treating practitioner, considering factors including, but not limited to: 
 
    The beneficiary's past history (including prior prosthetic use if applicable); and 
    The beneficiary's current condition including the status of the residual limb and the nature of other medical 
problems; and 
    The beneficiary's desire to ambulate. 
Clinical assessments of beneficiary rehabilitation potential must be based on the following classification levels: 
Level 0: Does not have the ability or potential to ambulate or transfer safely with or without assistance and a 
prosthesis does not enhance their quality of life or mobility. 
Level 1: Has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed 
cadence. Typical of the limited and unlimited household ambulator. Level 2: Has the ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stairs or uneven surfaces. Typical of the limited community ambulator. 
Level 3: Has the ability or potential for ambulation with variable cadence. Typical of the community ambulator 
who has the ability to traverse most environmental barriers and may have vocational, therapeutic, or exercise 
activity that demands prosthetic utilization beyond simple locomotion. 
Level 4: Has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting 
high impact, stress, or energy levels. Typical of the prosthetic demands of the child, active adult, or athlete. 
The records must document the beneficiary's current functional capabilities and his/her expected functional 
potential, including an explanation for the difference, if that is the case. It is recognized, within the functional 
classification hierarchy, that bilateral amputees often cannot be strictly bound by functional level 
classifications. You can find this information in Medicare's Local Coverage Determination (LCD): Lower 
Limb Prostheses (L33787). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.