Correct Coding - Martin Bionics Socket-less Socket™
DME MAC Joint Publication

The Socket-less Socket™ (Martin Bionics) is an open frame above-knee socket design. This product uses a combination of fixed and floating struts attached to a base and connected by adjustable straps to form the structure of the socket. The product is supplied as a prefabricated kit and fit directly to the beneficiary.

The existing HCPCS L-codes for base prosthesis and replacement sockets used for above-knee lower limb prosthesis sockets are not appropriate for this product. Existing base and socket codes describe items that enclose the residual limb to provide the stability, proprioception, and suspension necessary for the effective use of the artificial limb. These codes describe custom fabricated (molded to a patient model) sockets. The appropriate code for the Socket-less Socket™ is:

L5999 - LOWER EXTREMITY PROSTHESIS, NOT OTHERWISE SPECIFIED

Code L5999 is billed as 1 unit of service (UOS) to describe all features and functions of the entire Socket-less Socket™ product. Use of multiple NOC codes or other L codes, except as specified below, is considered unbundling. When code L5999 is billed, the claim must include a narrative description of the item that includes:

• Manufacturer, and the brand name or number
• Information describing whether this socket is a new socket included as part of a complete prosthesis or a replacement socket for an existing prosthesis. If the socket is part of a complete prosthesis, specify whether the preparatory (L5590) or definitive (L5321) base code was used for the base prosthesis

This information must be entered in the narrative field of the electronic claim.

HCPCS add-on L-codes used to describe the type of suspension incorporated into the socket may be added to the claim. Use of more than one type of suspension is considered incorrect billing, (same/similar item).

HCPCS codes describing features that may not be necessary on all sockets may only be used when the feature is provided for the individual beneficiary. An example of a feature that is not automatically included in every socket or for all beneficiaries are (not all-inclusive) is L5920 - ADDITION, ENDOSKELETAL SYSTEM, ABOVE KNEE OR HIP DISARTICULATION, ALIGNABLE SYSTEM. The prosthetic record must include specific, detailed information justifying the need for each additional feature.

Test sockets (L5624 - ADDITION TO LOWER EXTREMITY, TEST SOCKET, ABOVE KNEE) are not necessary for the production of this socket design. Claims for L5624 in conjunction with this socket design are considered incorrect billing.

Refer to the Lower Limb Prosthesis Local Coverage Determination and related Policy Article for additional information on coverage, coding and documentation for artificial limbs.

For questions about correct coding, contact the Pricing, Data Analysis and Coding (PDAC) contractor Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form.