2025 HCPCS code L5673
(Active) Effective Date: N/A Revision Date: N/A Prosthetic Procedures - Socket Insert, Suspensions, and Other Prosthetic Additions Orthotics and Prosthetic Appliances Feed
Socket insert for lower extremity prosthesis (below or above knee amputation); custom fabricated; silicone gel or elastomer; for use with locking mechanism.
Modifiers may apply depending on circumstances.For example, modifiers could be used to indicate bilateral use (e.g., -50) or other relevant circumstances.Refer to your local Medicare Administrative Contractor (MAC) and/or private payer guidelines for allowed modifiers.
Medical necessity is established when the socket insert is deemed necessary to improve the comfort, fit, and function of the lower-extremity prosthesis, preventing skin breakdown, and improving the patient's mobility and quality of life. This should be documented in the patient’s medical records.
The clinical responsibility lies with the prosthetist who fits and fabricates the prosthetic device and its components for the patient.The physician's role is in ordering the device based on the patient's needs and assessing the patient's overall prosthetic care.
In simple words: This code covers a special liner for a prosthetic leg.It's custom-made for the patient's leg and is made of soft material to help it fit well and be more comfortable. This liner is designed to work with a special locking system in the prosthetic leg.
This HCPCS code represents a custom-fabricated socket insert for a lower extremity prosthesis.It's designed for patients with above-knee or below-knee amputations. The insert is made from silicone gel or elastomeric material and is specifically intended for use with a locking mechanism.It's typically used to enhance comfort, improve fit, and protect the residual limb.
Example 1: A patient with a below-knee amputation receives a new prosthetic socket.A custom-fabricated silicone gel socket insert (L5673) is provided to enhance comfort and fit within the socket, using a locking mechanism to secure it in place., A patient with an above-knee amputation experiences increased discomfort in their existing prosthetic socket.Their prosthetist fabricates a new custom silicone elastomer socket insert (L5673) compatible with their existing locking system to alleviate pressure points and improve comfort., A child with a congenital below-knee amputation requires a new prosthetic socket and a custom-fitted liner. The prosthetist uses code L5673 for a silicone gel socket insert designed for use with a locking mechanism to ensure proper fit and comfort.
* Physician's order for the prosthetic device and liner.* Documentation of the patient's amputation type (above-knee or below-knee).* Detailed measurements and casting of the residual limb.* Specifications of the liner material (silicone gel or elastomer).* Confirmation that the liner is designed for use with a locking mechanism.* Documentation of the fitting and adjustment of the liner.
** This code is specific to custom-fabricated socket inserts for use with locking mechanisms.Ensure the insert's compatibility with the locking mechanism is clearly documented.
- RVU: RVUs will vary based on payer and location.Consult your local Medicare Administrative Contractor (MAC) or private payer for specific payment rates and relative value units.
- Global Days: Not applicable.This is a prosthetic supply, not a surgical procedure.
- Payment Status: Active
- Modifier TC rule: Not applicable. This is a supply, not a procedure with a technical component.
- Fee Schedule: Historical fee schedule data can vary significantly by payer and geographic location.Consult historical fee schedules from your relevant payer and MAC for specific information.
- Specialties:Prosthetics, Orthotics
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center