Correct Coding of Thermoformable Liners/Inserts

Thermoformable liners are prefabricated silicone socket inserts that can be used in upper and lower extremity prosthetics with or without a locking mechanism. Thermoformable liners/inserts have the ability to be heated to intimately fit a beneficiary. This ability to be heated and remolded does NOT make the themoformable liners/inserts qualify as custom fabricated. The thermoformable liners/inserts are still considered prefabricated regardless of their ability to be heated and reformed. Therefore, all themorformable liners/inserts that are manufactured in bulk and that have the ability to be heated and reformed are classified by the SADMERC as prefabricated. Heating and molding of the prosthesis is considered to be part of the fitting and adjustment of a prefabricated liner/insert.

The correct codes for lower extremity thermoformable liners/inserts are L5673 (Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism or L5679 (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).

The correct code for upper extremity thermoformable liners/inserts is L7499 (Upper extremity prosthesis, NOS. Should specific codes become available in the future, the prefabricated codes should be used.

The following codes are not appropriate HCPCS codes to use to bill prefabricated thermoformable liners.

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) and 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).

Published by Palmetto GBA as the SADMERC, September 2005. Republished by Noridian as the PDAC, August 2008. Republished by Palmetto GBA as the PDAC, January 2019.

Published by Noridian as the PDAC, September 22, 2005. Republished by Palmetto GBA as the PDAC, January 2019.