HCPCS Range Socket Insert, Suspensions, and Other Prosthetic Additions

• 1 Addition to lower extremity, socket insert, Symes, (Kemblo, Pelite, Aliplast, Plastazote or equal) ( L5654 )

• 2 Addition to lower extremity, socket insert, below knee (Kemblo, Pelite, Aliplast, Plastazote or equal) ( L5655 )

• 3 Addition to lower extremity, socket insert, knee disarticulation (Kemblo, Pelite, Aliplast, Plastazote or equal) ( L5656 )

• 4 Addition to lower extremity, socket insert, above knee (Kemblo, Pelite, Aliplast, Plastazote or equal) ( L5658 )

• 5 Addition to lower extremity, socket insert, multi-durometer Symes ( L5661 )

• 6 Addition to lower extremity, socket insert, multi-durometer, below knee ( L5665 )

• 7 Addition to lower extremity, below knee, cuff suspension ( L5666 )

• 8 Addition to lower extremity, below knee, molded distal cushion ( L5668 )

• 9 Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert ( L5671 )

• 10 Addition to lower extremity, below knee, removable medial brim suspension ( L5672 )

• 11 Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism ( L5673 )

• 12 Additions to lower extremity, below knee, knee joints, single axis, pair ( L5676 )

• 13 Additions to lower extremity, below knee, knee joints, polycentric, pair ( L5677 )

• 14 Additions to lower extremity, below knee, joint covers, pair ( L5678 )

• 15 Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism ( L5679 )

• 16 Addition to lower extremity, below knee, thigh lacer, nonmolded ( L5680 )

• 17 Addition to lower extremity, below knee/above knee, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code L5673 or L5679) ( L5681 )

• 18 Addition to lower extremity, below knee, thigh lacer, gluteal/ischial, molded ( L5682 )

• 19 Addition to lower extremity, below knee/above knee, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code L5673 or L5679) ( L5683 )

• 20 Addition to lower extremity, below knee, fork strap ( L5684 )

• 21 Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each ( L5685 )

• 22 Addition to lower extremity, below knee, back check (extension control) ( L5686 )

• 23 Addition to lower extremity, below knee, waist belt, webbing ( L5688 )

• 24 Addition to lower extremity, below knee, waist belt, padded and lined ( L5690 )

• 25 Addition to lower extremity, above knee, pelvic control belt, light ( L5692 )

• 26 Addition to lower extremity, above knee, pelvic control belt, padded and lined ( L5694 )

• 27 Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each ( L5695 )

• 28 Addition to lower extremity, above knee or knee disarticulation, pelvic joint ( L5696 )

• 29 Addition to lower extremity, above knee or knee disarticulation, pelvic band ( L5697 )

• 30 Addition to lower extremity, above knee or knee disarticulation, Silesian bandage ( L5698 )

• 31 All lower extremity prostheses, shoulder harness ( L5699 )

• 32 Addition to lower extremity, below knee, molded supracondylar suspension ('PTS' or similar) ( L5670 )