L57 — HCPCS Level II Codes

• L5700 Replacement, socket, below knee, molded to patient model billable
• L5701 Replacement, socket, above knee/knee disarticulation, including attachment plate, molded to patient model billable
• L5702 Replacement, socket, hip disarticulation, including hip joint, molded to patient model billable
• L5703 Ankle, symes, molded to patient model, socket without solid ankle cushion heel (sach) foot, replacement only billable
• L5704 Custom shaped protective cover, below knee billable
• L5705 Custom shaped protective cover, above knee billable
• L5706 Custom shaped protective cover, knee disarticulation billable
• L5707 Custom shaped protective cover, hip disarticulation billable
• L5710 Addition, exoskeletal knee-shin system, single axis, manual lock billable
• L5711 Additions exoskeletal knee-shin system, single axis, manual lock, ultra-light material billable
• L5712 Addition, exoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee) billable
• L5714 Addition, exoskeletal knee-shin system, single axis, variable friction swing phase control billable
• L5716 Addition, exoskeletal knee-shin system, polycentric, mechanical stance phase lock billable
• L5718 Addition, exoskeletal knee-shin system, polycentric, friction swing and stance phase control billable
• L5722 Addition, exoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control billable
• L5724 Addition, exoskeletal knee-shin system, single axis, fluid swing phase control billable
• L5726 Addition, exoskeletal knee-shin system, single axis, external joints fluid swing phase control billable
• L5728 Addition, exoskeletal knee-shin system, single axis, fluid swing and stance phase control billable
• L5780 Addition, exoskeletal knee-shin system, single axis, pneumatic/hydra pneumatic swing phase control billable
• L5781 Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system billable
• L5782 Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy duty billable
• L5783 Addition to lower extremity, user adjustable, mechanical, residual limb volume management system (with or without lamination kit) billable
• L5785 Addition, exoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) billable
• L5790 Addition, exoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal) billable
• L5795 Addition, exoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal) billable