Browse HCPCS Level II 2020 Edition

L5629 - L5653  Prosthetic Procedures - Lower Limb - Additions to Socket Variations

L5629 Addition to lower extremity, below knee, acrylic socket short Below knee acrylic socket MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L5630 Addition to lower extremity, symes type, expandable wall socket short Syme typ expandabl wall sckt MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L5631 Addition to lower extremity, above knee or knee disarticulation, acrylic socket short Ak/knee disartic acrylic soc MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L5632 Addition to lower extremity, symes type, 'ptb' brim design socket short Symes type ptb brim design s MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L5634 Addition to lower extremity, symes type, posterior opening (canadian) socket short Symes type poster opening so MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L5636 Addition to lower extremity, symes type, medial opening socket short Symes type medial opening so MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L5637 Addition to lower extremity, below knee, total contact short Below knee total contact MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L5638 Addition to lower extremity, below knee, leather socket short Below knee leather socket MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L5639 Addition to lower extremity, below knee, wood socket short Below knee wood socket MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L5640 Addition to lower extremity, knee disarticulation, leather socket short Knee disarticulat leather so MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L5642 Addition to lower extremity, above knee, leather socket short Above knee leather socket MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L5643 Addition to lower extremity, hip disarticulation, flexible inner socket, external frame short Hip flex inner socket ext fr MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L5644 Addition to lower extremity, above knee, wood socket short Above knee wood socket MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L5645 Addition to lower extremity, below knee, flexible inner socket, external frame short Bk flex inner socket ext fra MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L5646 Addition to lower extremity, below knee, air, fluid, gel or equal, cushion socket short Below knee cushion socket MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L5647 Addition to lower extremity, below knee suction socket short Below knee suction socket MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L5648 Addition to lower extremity, above knee, air, fluid, gel or equal, cushion socket short Above knee cushion socket MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L5649 Addition to lower extremity, ischial containment/narrow m-l socket short Isch containmt/narrow m-l so MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L5650 Additions to lower extremity, total contact, above knee or knee disarticulation socket short Tot contact ak/knee disart s MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L5651 Addition to lower extremity, above knee, flexible inner socket, external frame short Ak flex inner socket ext fra MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L5652 Addition to lower extremity, suction suspension, above knee or knee disarticulation socket short Suction susp ak/knee disart MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration

L5653 Addition to lower extremity, knee disarticulation, expandable wall socket short Knee disart expand wall sock MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration DME 2.0 2 Date of Service Edit: Policy Anatomic Consideration