For many people with lower-limb amputations, a well-fitting socket in the morning does not always mean a well-fitting socket throughout the entire day.
Residual limb volume changes are a common challenge in prosthetic care. As the limb changes shape due to activity, temperature, time in the socket, fluid shifts, or daily wear, patients may experience changes in socket fit.
For clinicians, this can create a difficult balance: helping patients maintain a secure and comfortable fit while minimizing the need for repeated adjustments, sock changes, or interruptions throughout the day.
The Overlay by Ethnocare was designed to help address this challenge.
Adjustable Socket Fit, Directly Inside the Prosthesis
The Overlay is a breathable fabric sleeve with an integrated air expansion system. It is worn inside the socket and allows users to make fit adjustments by adding or releasing air, helping manage daily volume fluctuations without removing the prosthesis.
Instead of relying only on traditional prosthetic socks or fixed socket volume, the Overlay adds an adjustable layer inside the socket. This allows users to fine-tune their fit as their residual limb changes throughout the day.
The goal is simple: help transform a rigid socket environment into an adjustable one.
Available for Transtibial and Transfemoral Users
Many clinicians are already familiar with the Overlay TT for below-knee users. The Overlay TF brings the same adjustable air technology to above-knee users, supporting patients who experience daily socket fit changes in transfemoral sockets.
The Overlay is available for:
- Transtibial users
- Transfemoral users
- K1 to K4 activity level patients
- Multiple suspension methods
- A wide range of socket and liner configurations
With a broad size range, the Overlay is designed to fit the large majority of lower-limb amputees and integrate into existing clinical workflows.
Designed for Real-World Compatibility
The Overlay is compatible with most existing liners and sockets. It can be used with common lower-limb prosthetic setups, including:
- Distal fixation systems
- Suspension sleeves
- Seal ring liners
- Passive vacuum systems
- Active vacuum systems
This flexibility allows clinicians to consider the Overlay for a wide range of patient profiles, including users who experience daily volume changes, discomfort from inconsistent fit, or the need to adjust their setup throughout the day.
US Reimbursement Pathway
The Overlay TT and Overlay TF have a dedicated HCPCS code in the United States:
- L5657 / Addition to lower extremity prosthesis, manual/automated adjustable air, fluid, gel or equal socket insert for limb volume management, any materials
CMS has reviewed the 2026 fee schedule for L5657, effective April 1, 2026. This creates a clearer reimbursement pathway for clinics providing the Overlay to eligible patients.
As with any prosthetic component, coverage and billing should be supported by appropriate clinical documentation, patient need, payer requirements, and the prosthetist’s professional judgment.
Dispensing Considerations
Because the Overlay is a wearable interface product used inside the socket, clinics may consider patient-specific needs such as hygiene, wear schedule, drying time, replacement timing, and clinical justification when determining how many units are appropriate.
Because of this, clinicians can determine that more than one unit is clinically appropriate, particularly when the patient’s daily use, hygiene routine, or replacement needs support that decision.
Ethnocare provides reimbursement support resources to help clinics understand product documentation and patient selection considerations.
Available Through Trusted US Distributors
The Overlay is available through major US O&P distributors, including:
- Hanger
- SPS
- Cascade
- PEL
Clinics can order through their preferred distributor and contact Ethnocare for product questions, sizing support, fitting guidance, or reimbursement resources.
Learn More
The Overlay gives clinicians a practical way to help patients manage daily socket fit changes with an adjustable and easy-to-use solution available for both transtibial and transfemoral users.
To learn more about sizing, fitting, patient selection, or reimbursement documentation, contact your local distributor or reach out to Ethnocare at clinics@ethnocare.ca.
