2025 HCPCS code L5700

Replacement socket for a below-knee amputation prosthesis, molded to a patient model.

Appropriate HCPCS coding guidelines should be followed for prosthetic devices.Documentation must support the medical necessity and the custom fabrication process.

Modifiers may be applicable depending on circumstances, such as 52 (reduced services) if the socket fabrication is incomplete, or modifiers indicating the side (left or right) the prosthesis is fitted for.

Medical necessity is established by documented changes in the residual limb's size or shape, or damage to the existing socket that compromises the safety and function of the prosthesis.The physician should document the patient's symptoms and the impact on their mobility and quality of life.

The clinical responsibility involves taking precise measurements and creating a model of the patient's residual limb. This model is used to fabricate a custom-fit socket that ensures proper alignment, comfort, and function of the prosthesis.Post-fitting adjustments might also be required.

IMPORTANT L5701 (Replacement socket, above knee or knee disarticulation), L5702 (Replacement socket, hip disarticulation)

In simple words: This code covers the cost of a new socket for a prosthetic leg (below the knee).The new socket is custom-made to fit the patient's leg, as the shape and size of the leg may have changed since the last socket.

This HCPCS code, L5700, represents a replacement socket for a below-knee amputation prosthesis.The socket is custom fabricated and molded to a model of the patient's residual limb. It may include a pad or liner for increased comfort.This is necessary because the residual limb may have changed shape and size since the original socket was provided.

Example 1: A patient with a below-knee amputation, fitted with a prosthesis several years ago, experiences discomfort and poor fit due to changes in their residual limb.A new socket (L5700) is fabricated., A patient experiences significant weight loss post-surgery, resulting in a loose and ill-fitting socket.A replacement socket (L5700) is required for proper function and comfort., A patient with a below-knee amputation requires a replacement socket due to damage or wear and tear on the existing socket. The new socket (L5700) ensures the prosthesis remains safe and functional.

** The fabrication of the socket often involves multiple visits for assessment, molding, and fitting.The cost should reflect the complexity of the process.It is crucial to document the type of materials used and any specific design features.Always refer to the latest HCPCS coding guidelines.

  • Payment Status: Active
  • Modifier TC rule: A Technical Component (TC) modifier is not typically applied to this code, as it represents a comprehensive procedure.
  • Specialties:Prosthetics, Orthopedics, Physical Medicine and Rehabilitation
  • Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center
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