2025 HCPCS code L5540
Effective Date: N/A Prosthetic Procedures Feed
Preparatory, below knee 'PTB' type socket, non-alignable system, pylon, no cover, SACH foot, laminated socket, molded to model.
Medical necessity for this code is established when a patient requires a temporary prosthesis for initial ambulation and adaptation following a below-knee amputation, before a permanent prosthesis can be fitted.
In simple words: This code is for a temporary artificial leg used after a below-knee amputation. It helps the patient get used to walking with a prosthesis before they receive their permanent one. This temporary leg has a special socket that fits over the stump, a connecting piece (pylon), and a basic, non-moving foot.
This code represents a preparatory below-knee prosthesis system used after amputation. It includes a non-adjustable patellar tendon-bearing (PTB) socket, a pylon, and a solid ankle cushioned heel (SACH) foot. The socket is laminated and molded to the patient's model, but does not include a cover.
Example 1: A patient undergoes a below-knee amputation due to complications from diabetes. A preparatory prosthesis is fitted to allow the patient to begin ambulating and adapt to prosthetic use before a definitive prosthesis is fabricated., A patient with a recent below-knee amputation requires a preparatory prosthesis to facilitate wound healing and allow for volume changes in the residual limb before fitting a permanent prosthesis., Following a traumatic below-knee amputation, a patient is fitted with a preparatory prosthesis to initiate early ambulation and improve rehabilitation outcomes.
Documentation should include the medical necessity for the preparatory prosthesis, details of the amputation, and the specific components included (socket type, pylon, foot type).
** This preparatory prosthesis is a temporary solution, and the patient will typically be fitted with a permanent, more advanced prosthesis later in their recovery. Refer to the iFrameAI product for the most accurate and up-to-date information regarding this and other codes, as HCPCS codes and guidelines can change.
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