2025 HCPCS code L5679
(Active) Effective Date: N/A Revision Date: N/A Prosthetic Procedures - Socket Insert Orthotic Devices Feed
This HCPCS code represents a custom-fabricated or prefabricated socket insert for a lower extremity prosthesis (above or below knee), made of silicone gel, elastomer, or similar material; not for use with a locking mechanism.
Modifiers may be applicable depending on the circumstances. Consult the most current modifier guidelines for appropriate use.
Medical necessity for L5679 is established when documentation supports the need for improved comfort, skin protection, or improved fit of the lower extremity prosthesis.This may be due to changes in the residual limb, skin irritation, or pressure sores.The absence of a locking mechanism should be clearly documented.
Prosthetists or other qualified healthcare professionals involved in prosthetic fitting and management are responsible for assessing the patient's needs, selecting appropriate components, fabricating or fitting the socket insert, and providing patient education on proper use and care.
- Orthotic Devices
- L5000-L9900 > Socket Insert, Suspensions, and Other Prosthetic Additions > L5654-L5699
In simple words: This code is for a special cushion that goes inside a prosthetic leg (artificial leg) for someone who has had their leg amputated above or below the knee.It's made of soft material and helps make the prosthetic more comfortable and protects the skin.This type of cushion doesn't work with certain types of locking systems.
HCPCS code L5679 describes an addition to a lower extremity prosthesis, specifically a socket insert for above or below knee amputations.The insert is custom fabricated from an existing mold or prefabricated and composed of silicone gel, elastomeric material, or an equivalent. This particular insert is explicitly designed for use without a locking mechanism.The clinical purpose is to provide cushioning, improve comfort, and protect the residual limb from skin breakdown.It's important to note that this code is distinct from L5673, which is used for inserts compatible with locking mechanisms.
Example 1: A patient with a below-knee amputation receives a new prosthesis.A silicone gel socket insert (L5679) is fitted to enhance comfort and protect the residual limb, as the patient will be using the prosthesis for everyday ambulation., A patient with an above-knee amputation experiences increased residual limb discomfort. After evaluation, a new, custom-fabricated silicone elastomeric socket insert (L5679) is added to their existing prosthesis to improve fit and reduce pressure points., Following a revision of a below knee prosthesis, the patient requires a replacement socket insert.Due to the absence of a locking mechanism, a silicone gel socket insert (L5679) is supplied.
* Documentation of the amputation (type and level).* Medical necessity for the socket insert (e.g., residual limb discomfort, skin breakdown prevention).* Specifications of the insert material (silicone gel, elastomer, or equivalent).* Confirmation that the insert is not for use with a locking mechanism.* Documentation supporting the fitting and patient education.
** This code should only be used for socket inserts that are not compatible with locking mechanisms.Always verify the specific characteristics of the insert before assigning the code. Refer to the manufacturer's instructions for clarification.
- Payment Status: Active
- Modifier TC rule: Not applicable.This is a supply code.
- Fee Schedule: Fee schedules vary based on payer and location. Consult payer-specific fee schedules for historical data.
- Specialties:Prosthetics, Orthotics, Physical Medicine and Rehabilitation
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center