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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 L5781 describes a complete device that is an addition to a lower limb prosthesis. The 
primary function of the vacuum pump is to suspend the prosthetic limb. Additionally, products coded L5781 
provide residual limb volume management and moisture evacuation. The pump mechanism evacuates air and 
accumulated moisture between the limb and socket walls. The pump mechanism can be actuated by either 
external power and/or mechanical system(s). 
 
L5782 describes a complete device that is an addition to a lower limb prosthesis. The primary function of the 
vacuum pump is to suspend the prosthetic limb. It also provides residual limb volume management and 
moisture evacuation. The pump mechanism evacuates air and accumulated moisture between the limb and 
socket walls. The pump mechanism can be actuated by either external power and/or mechanical system(s). 
Products described by this code would have components built to withstand higher prosthetic limb forces than 
L5781. 
 
L5988 describes an endoskeletal pylon device that allows vertical shock reduction between the foot and pelvis 
during ambulation. The vertical shock reducing pylon feature of L5988 is a separate function from other 
products which use a piston/telescoping mechanism such as products described by L5781 or L5782. The 
predicate product is the Total Shock that was manufactured by Century XXII International, Inc. 
 
ANKLE AND LOWER EXTREMITY MOTION UNITS 
 
Codes L5968, L5982, L5984, L5985, L5986 and L5988 describe separate products which provide either a 
single motion or a combination of motions generally attributed to functional movement of the lower limb 
during ambulation. The use of these codes can be used to fully describe additional features or functions not 
found in the prosthetic foot system (L5969, L5970, L5971, L5972, L5973, L5974, L5975, L5976, L5978, 
L5979 L5980, L5981 and L5987). 
L5968 describes a product that is used as an addition to L-code foot systems for lower limb prosthesis 
construction. The product provides multiaxial motion in the coronal and sagittal plane from articulating 
components. At transition of stance phase to swing phase, the product will increase the ankles dorsiflexion 
angle and maintain it throughout swing phase. The product provides an accommodation of changing heel heights without the users input. The predicate product is the Rincoe R-Hab Ankle manufactured by R.G. 
Rincoe & Associates, Inc. 
 
Use of L5968, L5982, L5984 or L5986 is based on the beneficiarys K-level modifier (K0-K4), as referenced 
in the LCD. 
 
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, L5980, 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. 
 
You can find these rules in the Local Coverage Article Lower Limb Prostheses - Policy Article A52496. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.