2025 HCPCS code L5681
(Active) Effective Date: N/A Revision Date: N/A Prosthetics - Socket Inserts L (Orthotics, Prosthetics, and Supplies) Feed
Initial supply of a custom-fabricated socket liner made of silicone gel or elastomeric material for congenital or atypically traumatically amputated limbs (above or below knee).
Modifiers may apply depending on the circumstances of service.Consult the most up-to-date modifier guidelines.
The medical necessity is established by the physician's order indicating that a custom-fabricated socket liner is necessary for proper prosthetic fitting and function for a patient with congenital limb deficiency or an atypical traumatic amputation.The liner improves comfort, fit and reduces the likelihood of skin breakdown.
Prosthetist or Orthotist
- L (Orthotics, Prosthetics, and Supplies)
- L5654-L5699 (Socket Insert, Suspensions, and Other Prosthetic Additions)
In simple words: This code covers the cost of a special custom-made liner for a prosthetic leg or arm. This liner is made of a soft, rubbery material and goes between the patient's limb and the artificial limb. It's only for people who lost a limb because of birth defects or an unusual accident. This code is for the first time the liner is provided; there are other codes for getting more liners later.
This HCPCS code, L5681, represents the initial provision of a custom-fabricated socket liner.The liner is constructed from silicone gel or a comparable elastomeric material and is designed to fit within the socket of a prosthesis, situated between the patient's residual limb and the prosthetic device. This code is specifically for patients with limb loss resulting from congenital conditions or atypical traumatic events.It can be used with prostheses for both above-knee and below-knee amputations, regardless of whether a socket locking mechanism is present.This code is only for the initial supply; subsequent supplies use codes L5673 or L5679, depending on the locking mechanism.
Example 1: A patient born with a below-knee limb deficiency receives their first custom-fabricated silicone gel socket liner for their prosthesis. Code L5681 is used., A patient sustains an atypical leg injury in an industrial accident, resulting in above-knee amputation.They receive an initial custom-fabricated socket liner with a locking mechanism. Code L5681 is billed., A patient with a congenital above-knee amputation receives their first custom silicone gel liner without a locking mechanism. L5681 is reported.
Physician's order specifying the need for a custom-fabricated socket liner;documentation of the patient's amputation (congenital or atypical traumatic);detailed measurements of the residual limb;specifications of the liner material (silicone gel or equivalent); indication of whether a locking mechanism is used.
** Accurate documentation is crucial for proper reimbursement.Ensure that the documentation supports the medical necessity and the specifics of the liner (material, locking mechanism, etc.).The use of codes L5673 and L5679 for subsequent supplies must be correctly determined based on whether a locking mechanism is present.
- Payment Status: Active
- Specialties:Prosthetics, Orthotics, Physical Medicine and Rehabilitation
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center