Braces; trusses; and artifical legs, arms, and eyes are covered when furnished incident to a physician’s services or on a physician’s order. A brace includes rigid and semirigid devices used for the purpose of supporting a weak or deformed body member or restricting or eliminating motion in a diseased or injured part of the body. Back braces include, but are not limited to, sacroiliac, sacrolumbar, dorsolumbar corsets, and belts. Stump stockings and harnesses (including replacements) are also covered when these appliances are essential to the effective use of an artificial limb. Adjustments to an artificial limb or other appliance required by wear or by a change in the patient’s condition are covered when ordered by a physician. Adjustments, repairs, and replacements are covered so long as the device continues to be medically required.

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• L5540

  Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, laminated socket, molded to model

• L5560

  Preparatory, above knee- knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model

• L5570

  Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed

• L5580

  Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model

• L5585

  Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, prefabricated adjustable open end socket

• L5590

  Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon no cover, sach foot, laminated socket, molded to model

• L5595

  Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, thermoplastic or equal, molded to patient model

• L5600

  Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, laminated socket, molded to patient model

• L5610

  Addition to lower extremity, endoskeletal system, above knee, hydracadence system

• L5611

  Addition to lower extremity, endoskeletal system, above knee - knee disarticulation, 4 bar linkage, with friction swing phase control

• L5613

  Addition to lower extremity, endoskeletal system, above knee-knee disarticulation, 4 bar linkage, with hydraulic swing phase control

• L5614

  Addition to lower extremity, exoskeletal system, above knee-knee disarticulation, 4 bar linkage, with pneumatic swing phase control

• L5615

  Addition, endoskeletal knee-shin system, 4 bar linkage or multiaxial, fluid swing and stance phase control

• L5616

  Addition to lower extremity, endoskeletal system, above knee, universal multiplex system, friction swing phase control

• L5617

  Addition to lower extremity, quick change self-aligning unit, above knee or below knee, each

• L5618

  Addition to lower extremity, test socket, symes

• L5620

  Addition to lower extremity, test socket, below knee

• L5622

  Addition to lower extremity, test socket, knee disarticulation

• L5624

  Addition to lower extremity, test socket, above knee

• L5626

  Addition to lower extremity, test socket, hip disarticulation

• L5628

  Addition to lower extremity, test socket, hemipelvectomy

• L5629

  Addition to lower extremity, below knee, acrylic socket

• L5630

  Addition to lower extremity, symes type, expandable wall socket

• L5631

  Addition to lower extremity, above knee or knee disarticulation, acrylic socket

• L5632

  Addition to lower extremity, symes type, 'ptb' brim design socket

• L5634

  Addition to lower extremity, symes type, posterior opening (canadian) socket

• L5636

  Addition to lower extremity, symes type, medial opening socket

• L5637

  Addition to lower extremity, below knee, total contact

• L5638

  Addition to lower extremity, below knee, leather socket

• L5639

  Addition to lower extremity, below knee, wood socket

• L5640

  Addition to lower extremity, knee disarticulation, leather socket

• L5642

  Addition to lower extremity, above knee, leather socket

• L5643

  Addition to lower extremity, hip disarticulation, flexible inner socket, external frame

• L5644

  Addition to lower extremity, above knee, wood socket

• L5645

  Addition to lower extremity, below knee, flexible inner socket, external frame

• L5646

  Addition to lower extremity, below knee, air, fluid, gel or equal, cushion socket

• L5647

  Addition to lower extremity, below knee suction socket

• L5648

  Addition to lower extremity, above knee, air, fluid, gel or equal, cushion socket

• L5649

  Addition to lower extremity, ischial containment/narrow m-l socket

• L5650

  Additions to lower extremity, total contact, above knee or knee disarticulation socket

• L5651

  Addition to lower extremity, above knee, flexible inner socket, external frame

• L5652

  Addition to lower extremity, suction suspension, above knee or knee disarticulation socket

• L5653

  Addition to lower extremity, knee disarticulation, expandable wall socket

• L5654

  Addition to lower extremity, socket insert, symes, (kemblo, pelite, aliplast, plastazote or equal)

• L5655

  Addition to lower extremity, socket insert, below knee (kemblo, pelite, aliplast, plastazote or equal)

• L5656

  Addition to lower extremity, socket insert, knee disarticulation (kemblo, pelite, aliplast, plastazote or equal)

• L5657

  Addition to lower extremity prosthesis, manual/automated adjustable air, fluid, gel or equal socket insert for limb volume management, any materials

• L5658

  Addition to lower extremity, socket insert, above knee (kemblo, pelite, aliplast, plastazote or equal)

• L5661

  Addition to lower extremity, socket insert, multi-durometer symes

• L5665

  Addition to lower extremity, socket insert, multi-durometer, below knee

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HCPCS Level II codes and descriptors are approved and maintained jointly by the alpha-numeric editorial panel (consisting of CMS, the Health Insurance Association of America, and the Blue Cross and Blue Shield Association). — Updated 6/4/2026

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