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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• L5666

  Addition to lower extremity, below knee, cuff suspension

• L5668

  Addition to lower extremity, below knee, molded distal cushion

• L5670

  Addition to lower extremity, below knee, molded supracondylar suspension ('pts' or similar)

• L5671

  Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert

• L5672

  Addition to lower extremity, below knee, removable medial brim suspension

• L5673

  Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, for use with locking mechanism

• L5676

  Additions to lower extremity, below knee, knee joints, single axis, pair

• L5677

  Additions to lower extremity, below knee, knee joints, polycentric, pair

• L5678

  Additions to lower extremity, below knee, joint covers, pair

• L5679

  Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, not for use with locking mechanism

• L5680

  Addition to lower extremity, below knee, thigh lacer, nonmolded

• L5681

  Addition to lower extremity, below knee/above knee, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l5673 or l5679)

• L5682

  Addition to lower extremity, below knee, thigh lacer, gluteal/ischial, molded

• L5683

  Addition to lower extremity, below knee/above knee, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l5673 or l5679)

• L5684

  Addition to lower extremity, below knee, fork strap

• L5685

  Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each

• L5686

  Addition to lower extremity, below knee, back check (extension control)

• L5688

  Addition to lower extremity, below knee, waist belt, webbing

• L5690

  Addition to lower extremity, below knee, waist belt, padded and lined

• L5692

  Addition to lower extremity, above knee, pelvic control belt, light

• L5694

  Addition to lower extremity, above knee, pelvic control belt, padded and lined

• L5695

  Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each

• L5696

  Addition to lower extremity, above knee or knee disarticulation, pelvic joint

• L5697

  Addition to lower extremity, above knee or knee disarticulation, pelvic band

• L5698

  Addition to lower extremity, above knee or knee disarticulation, silesian bandage

• L5699

  All lower extremity prostheses, shoulder harness

• L5700

  Replacement, socket, below knee, molded to patient model

• L5701

  Replacement, socket, above knee/knee disarticulation, including attachment plate, molded to patient model

• L5702

  Replacement, socket, hip disarticulation, including hip joint, molded to patient model

• L5703

  Ankle, symes, molded to patient model, socket without solid ankle cushion heel (sach) foot, replacement only

• L5704

  Custom shaped protective cover, below knee

• L5705

  Custom shaped protective cover, above knee

• L5706

  Custom shaped protective cover, knee disarticulation

• L5707

  Custom shaped protective cover, hip disarticulation

• L5710

  Addition, exoskeletal knee-shin system, single axis, manual lock

• L5711

  Additions exoskeletal knee-shin system, single axis, manual lock, ultra-light material

• L5712

  Addition, exoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)

• L5714

  Addition, exoskeletal knee-shin system, single axis, variable friction swing phase control

• L5716

  Addition, exoskeletal knee-shin system, polycentric, mechanical stance phase lock

• L5718

  Addition, exoskeletal knee-shin system, polycentric, friction swing and stance phase control

• L5722

  Addition, exoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control

• L5724

  Addition, exoskeletal knee-shin system, single axis, fluid swing phase control

• L5726

  Addition, exoskeletal knee-shin system, single axis, external joints fluid swing phase control

• L5728

  Addition, exoskeletal knee-shin system, single axis, fluid swing and stance phase control

• L5780

  Addition, exoskeletal knee-shin system, single axis, pneumatic/hydra pneumatic swing phase control

• L5781

  Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system

• L5782

  Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy duty

• L5783

  Addition to lower extremity, user adjustable, mechanical, residual limb volume management system (with or without lamination kit)

• L5785

  Addition, exoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)

• L5790

  Addition, exoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)

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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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