L5704 – Custom shaped protective cover, below knee

Long description

Custom shaped protective cover, below knee

Short description

Custom shape cover bk

Pricing indicator

38 Orthotics, prosthetics, prosthetic devices & vision services

Medicare coverage

C Carrier judgment – coverage decided by the Medicare contractor

BETOS category

D1F Prosthetic/Orthotic devices

Added

January 1, 1994

Last change

January 1, 2002 – No change

Nearby L codes

• 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
• 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