2025 HCPCS code L5020
(Active) Effective Date: N/A Revision Date: N/A Orthotics and Prosthetics - Partial Foot Prosthetics Prosthetic Procedures Feed
Supply of a partial foot prosthetic device consisting of a molded socket extending to tibial tubercle height, inclusive of a toe filler.
Modifiers may apply depending on the circumstances of service.Consult the official HCPCS modifier guidelines for appropriate modifier selection.
Medical necessity is established by the presence of a partial foot amputation resulting in functional impairment and the need for a prosthetic device to improve ambulation, weight-bearing, and overall quality of life. The device should be medically appropriate based on the patient's specific needs and condition.
The provider's clinical responsibilities include taking a mold or cast of the amputated portion of the foot.Post-amputation, the provider fabricates the socket using an appropriate material (e.g., rubber), ensuring proper fit and alignment with the residual limb.They connect the socket's anterior portion to the toe filler, extending the socket proximally to the tibial tubercle. A zipper closure is typically incorporated for secure application. The provider assesses the patient's needs and ensures the prosthesis functions correctly.They may also provide instructions and follow-up care.
In simple words: This code covers the cost of a special shoe and socket for someone who has had part of their foot amputated.The socket is custom-made to fit the remaining part of the foot and ankle, and it includes a filler to replace missing toes, making it easier to wear regular shoes.
HCPCS code L5020 represents the provision of a custom-molded socket for a partial foot prosthesis.This socket extends proximally to the tibial tubercle and includes a toe filler component. The device is designed to interface with the residual foot and ankle, providing support and function after partial foot amputation.The molded socket is typically constructed from a resilient material like rubber, and its design incorporates a rigid longitudinal arch support and material to compensate for missing digits or forefoot structures. The toe filler component prevents shoe upper collapse and maintains proper toe positioning.
Example 1: A patient presents post-partial foot amputation (e.g., Lisfranc amputation). The provider creates a custom molded socket (L5020) to provide support and improve function for the residual limb., A patient with diabetes experiences a partial foot amputation due to infection. The provider fabricates a custom-fit prosthetic socket (L5020) considering the patient's diabetic condition and ensuring optimal wound healing., A patient sustains a traumatic injury resulting in a partial foot amputation. Following surgery, the provider designs and creates a molded socket (L5020) integrating a toe filler to enhance comfort and mobility.
Detailed medical records including the diagnosis of partial foot amputation, the type of amputation (e.g., Lisfranc, Chopart), pre- and post-operative images (radiographs, photographs), and documentation of the socket's measurements, materials, and design specifications are required.
** The description includes a toe filler, which is integral to the device's function and should not be billed separately.Ensure that appropriate documentation supports the medical necessity and accurate fitting of the prosthesis.
- Payment Status: Active
- Specialties:Prosthetists/Orthotists, Podiatry, Surgery (e.g., Orthopedic, Vascular)
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center