In simple words: This code covers a custom-made, gel-like insert for a prosthetic arm (above or below the elbow) for someone born without a limb or who lost a limb due to unusual trauma. It helps make the prosthesis more comfortable and fit better.

This code covers the initial supply of a custom-fabricated socket insert made of silicone gel, elastomeric, or equivalent material for a below-elbow or above-elbow upper extremity prosthesis for a patient with a congenital or atypical traumatic amputation. The insert is designed to improve comfort and fit within the prosthetic socket, with or without a locking mechanism.

Example 1: A child born without a left forearm receives their first custom-fitted, silicone gel insert for their below-elbow prosthesis to improve comfort and fit., An adult with an above-elbow amputation resulting from a farming accident requires a custom-fabricated elastomeric socket insert for their new prosthesis. This is their first such insert., A patient with a congenital below-elbow limb difference receives their initial, custom-made silicone gel insert with a locking mechanism for enhanced stability and comfort within their above-elbow prosthesis.

Documentation should support the medical necessity of the custom-fabricated insert, specifying the patient's congenital or atypical traumatic amputation and the type of prosthesis (below-elbow or above-elbow). The initial nature of the insert should also be clearly documented.

** This code was retired on March 31, 2022. Always check the most current HCPCS code set for accurate billing.