The Centers for Medicare and Medicaid Services (CMS) has revised the Healthcare Common Procedure Coding System (HCPCS) codes for the Socket-less Socket™, Martin Bionics Innovations, Oklahoma City. The announcement,
through a Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Joint Publication, revises the coding article published March 10. HCPCS code L-5999 (Lower extremity prosthesis, not otherwise specified) has been replaced with specific L-codes; the revised coding requirements are effective for claims with dates of service on or after June 1.
The correct combination of codes to bill Medicare for the socket follows:
Base Code
If this product is included as part of a complete prosthesis, the base socket is included as part of the prosthesis base code. Choose the appropriate base code depending upon the type provided.
- L-5321 (Socket above knee, molded socket, open end, SACH foot, endoskeletal system, single axis knee)
- L-5590 (Preparatory, above knee-knee disarticulation ischial level socket, non-alignable system, pylon no cover, SACH foot, laminated socket, molded to model)
- L-5701 (Replacement, socket, above knee/knee disarticulation, including attachment plate, molded to patient model)
The addition codes and choice of suspension must be included on the same claim for the complete prosthesis, i.e., the claim that includes one of the above codes.
Addition Codes
Use these codes on all claims in addition to the base code:
- L-5631 (Addition to lower extremity, above knee or knee disarticulation, acrylic socket)
- L-5649 (Addition to lower extremity, ischial containment/narrow M-L socket)
- L-5950 (Addition, endoskeletal system, above knee, ultralight material (titanium, carbon fiber or equal))
