Prior Authorization
Humana Prior Authorization for CPT L5321
Above knee, molded socket, open end, sach foot, endoskeletal system, single axis knee · Standard commercial plans
Source
Data pending source-document linkage. Verify against Humana's current clinical policy before submission.
Not medical advice. PA policies change frequently. Always confirm against the payer's current policy before submitting. d3rx pulls directly from publicly published policy PDFs and refreshes daily.
Clinical criteria
Prosthetics
Documentation checklist
- ✓Clinical notes
2026 Medicare rate for CPT L5321
CPT L5321 is not priced under the 2026 Medicare Physician Fee Schedule — drugs/biologicals price under ASP and lab tests under the CLFS. See the CPT L5321 code page for pricing detail.
How to submit the PA
- 1Verify the requirement against the current clinical policy linked above.
- 2Gather documentation: Clinical notes.
- 3Submit via the payer's provider portal or designated PA channel.
- 4Document the reference number and follow up within 5 business days if no determination is received.
FAQ
- Does Humana require prior authorization for CPT L5321?
- Yes. Humana requires prior authorization for CPT L5321 (Above knee, molded socket, open end, sach foot, endoskeletal system, single axis knee) under Standard commercial plans per its published clinical policy.
- What documentation does Humana require for CPT L5321?
- Clinical notes
- What if Humana denies the PA for CPT L5321?
- Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.
Other Humana PA lookups
CPT L5321 prior authorization by payer
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