| HCPCS Code: |
L5679 |
| Long Description: |
Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism |
| Short Description: |
Socket insert w/o lock mech |
| Pricing Indicator 1: |
38 (Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)) |
| Multiple Pricing Code: |
A (Not applicable as HCPCS priced under one methodology) |
| Statute Number: |
|
| Coverage Code: |
C (Carrier judgment) |
| ASC Payment Group Code: |
|
| Processing Note Number: |
|
| Berenson-Eggers Type of Service (BETOS) Code: |
D1F (Orthotic devices) |
| Type of Service Code 1: |
P (Lump sum purchase of DME, prosthetics, orthotics) |
| Anesthesia Base Unit Quality: |
0 |
| Code Added: |
01-01-2004 |
| Action Effective Date: |
01-01-2004 |
| Action Code: |
N (No maintenance for this code) |
