A joint publication by the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) announced revised coding for the transtibial Infinite Socket, LIM Innovations, San Francisco. The DME MACs determined that the design of the Infinite Socket has critical design elements that meet the coding requirements for the following Healthcare Common Procedure Coding System (HCPCS) codes. The correct combination of HCPCS codes to bill Medicare are as follows:
- Base code for complete prosthesis (choose one)
- L-5301: Below knee, molded socket, shin, SACH foot, endoskeletal system
- L-5540: Preparatory, below knee “ptb” type socket, non-alignable system, pylon, no cover, SACH foot, laminated socket, molded to model
- Base code for socket replacement
- L-5700: Replacement, socket, below knee, molded to patient model
- Addition codes to always bill with one of the above base codes
- L-5629: Addition to lower extremity, below knee, acrylic socket
- L-5637: Addition to lower extremity, below knee, total contact
- L-5940: Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)
The add-on codes L-5629, L-5637, L-5940, and the HCPCS codes describing the choice of suspension must be included on the same claim for the complete prosthesis or socket replacement, i.e., the claim that includes one of the above base codes.
