Dynamic List Information
Dynamic List Data
HCPCS Code
L5683
On Master List?
Yes
Prior Authorization Required?
No
F2F and Written Order Prior to Delivery?
No
Description: 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)