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HCPCS L5160: Knee Disarticulation Molded Socket with Bent Knee and SACH Foot

HCPCS Level II code L5160 denotes a molded socket prosthesis for a knee disarticulation (through-knee) amputation configured with an external bent knee joint, shin component, and a SACH (solid ankle cushioned heel) foot. This code is used to bill for a complete custom prosthetic assembly addressing limb loss at or through the knee, an important category of durable medical equipment and prosthetic services with implications for mobility, rehabilitation outcomes, and long-term functional independence nationwide.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for L5160, typical sites of service where the prosthesis is delivered and adjusted, and the common billing environment for lower-limb prosthetic fabrication and fitting. The publication also summarizes benchmarking and coverage themes relevant to this code, highlights policy and coding considerations that affect reimbursement and documentation, and provides practical reference material for clinical and billing teams. Data not available in the input for associated taxonomies, specific ICD-10 pairings, and related codes are noted where appropriate.

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Billing Code Overview

HCPCS Level II code L5160 describes a knee disarticulation (through-knee) prosthetic socket with a molded socket, bent knee configuration, external knee joints, shin, and sach foot. This represents a custom lower-limb prosthetic assembly designed for patients with an amputation through the knee (knee disarticulation) or equivalent residual limb.

Service type: Prosthetic lower-limb socket and components (custom molded transtibial/knee-disarticulation prosthesis)
Typical site of service: Orthotics and prosthetics clinic, prosthetic fabrication lab, inpatient rehabilitation facility, or outpatient prosthetics fitting and adjustment setting

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HCPCS L5160: Knee Disarticulation Molded Socket with Bent Knee and SACH Foot

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Billing Code Overview

Service type: Prosthetic lower-limb socket and components (custom molded transtibial/knee-disarticulation prosthesis)
Typical site of service: Orthotics and prosthetics clinic, prosthetic fabrication lab, inpatient rehabilitation facility, or outpatient prosthetics fitting and adjustment setting

Clinical & Coding Specifications

Clinical Context

A 62-year-old male with a transtibial limb ischemia history presents after progressive peripheral arterial disease and recurrent nonhealing infection of the distal tibia and ankle. Surgical team performs a knee disarticulation (through-knee amputation) with a molded socket prosthetic plan. The prosthetist fabricates a molded socket in a bent knee configuration with external knee joints, a reinforced shin section, and a SACH foot to restore weight-bearing surfaces and ambulation.

Pre-procedure workflow includes vascular and orthopedic evaluation, wound care and infection control, pre-prosthetic planning with the prosthetist to document limb shape and expected socket alignment, and baseline functional assessment (gait, transfers). Postoperative care includes wound monitoring, residual limb shaping, shrinker or immediate postoperative dressing, prosthetic fitting sessions for socket casting or scanning, bench alignment of external knee joints, and progressive gait training with physical therapy. Follow-up includes socket adjustments, component tuning (knee friction or locking adjustments), and periodic replacement of the SACH foot and shin components as clinically indicated.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier used (default)	Applied when no specific modifier is required or applicable.
`11`	Professional Component	Use when billing only the clinician’s professional component of a service related to prosthetic fitting or adjustments when split components are reportable.
`22`	Increased Procedural Services	Use when work required is substantially greater than typical (extensive revisions or complex fittings).
`52`	Reduced Services	Use when a service is partially reduced or not completed as originally planned (limited prosthetic fabrication).
`53`	Discontinued Procedure	Use when the prosthetic fabrication or fitting is started but discontinued due to patient condition.
`54`	Surgical Care Only	Use by a surgeon when billing only the surgical portion if separate prosthetic services are billed by another provider.
`55`	Postoperative Management Only	Use when billing only post-op care related to the amputation and not the surgical procedure.
`62`	Two Surgeons	Use if two surgeons of different specialties perform distinct portions of the amputation.
`78`	Unplanned Return to OR	Use for an unplanned return to the operating room for related revision or complication within the global period.
`80`	Assistant Surgeon	Use when an assistant surgeon provides services during the amputation.
`82`	Assistant Surgeon (when qualified resident unavailable)	Use when an assistant surgeon is needed and a qualified resident is not available.
`AS`	Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Medicare	Use when services are furnished by these clinicians under Medicare rules.
`QK`	Medical Direction of Two, Three, or Four Auxiliaries	Use when the clinician medically directs multiple qualified assistants in prosthetic-related services.

Taxonomy Code	Specialty	Notes
`174500000X`	Orthopedic Surgery	Primary surgical specialty performing amputations and residual limb management.
`366A00000X`	Physical Medicine & Rehabilitation	Provides pre- and post-prosthetic rehabilitation and functional assessments.
`225100000X`	Prosthetics & Orthotics	Certified prosthetists who fabricate, fit, and align the molded socket, external knee joints, and SACH foot.
`207L00000X`	Vascular Surgery	Manages peripheral arterial disease and vascular indications leading to knee disarticulation.
`208M00000X`	General Surgery	May perform amputations in certain settings and coordinate surgical care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.239`	Atherosclerosis of native arteries of extremities, unspecified extremity, with ulceration	Peripheral arterial disease with tissue loss can lead to nonhealing wounds necessitating knee disarticulation.
`I70.241`	Atherosclerosis of native arteries of right leg with ulceration	Side-specific PAD causing limb-threatening ischemia and infection prompting amputation.
`L97.322`	Non-pressure chronic ulcer of right calf with necrosis of muscle	Chronic infected ulcer with deep tissue involvement that may require amputation.
`T84.84XA`	Infection and inflammatory reaction due to internal prosthetic device, implant and graft, initial encounter	Deep infection complicating prior hardware or implants that necessitates limb removal and prosthetic planning.
`C79.51`	Secondary malignant neoplasm of bone	Tumor involving distal femur or knee region requiring through-knee amputation for local control.
`M86.172`	Chronic osteomyelitis, right femur	Chronic bone infection that is refractory to conservative treatment and leads to knee disarticulation.
`G62.0`	Diabetic polyneuropathy	Diabetes-related neuropathy contributing to foot/leg ulceration and infection ultimately leading to amputation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27590`	Revision of amputation stump, femur or knee; major reconstruction	Used for surgical revision of residual limb after knee disarticulation when major stump reconstruction is required.
`29999`	Unlisted procedure, arthroscopy or laparoscopic procedures (example placeholder for unlisted lower extremity prosthetic-related surgical procedures)	Occasionally used when a specific CPT descriptor for a unique prosthetic-related surgical procedure is not available; requires operative report.
`97760`	Orthotic(s) management and training, initial encounter for fitting and training; lower extremity, single limb, manual or mechanical	Used for initial prosthetic training and gait training after fitting the molded socket and components.
`97763`	Orthotic(s)/prosthetic(s) training, gait training (includes stair climbing)	Used for ongoing prosthetic gait training sessions following delivery and alignment of the prosthesis.
`99455`	Work-related or medical disability examination (to determine eligibility for prosthesis)	Used when documenting functional capacity evaluations or disability assessments needed for prosthetic authorization.

HCPCS L5000: Partial Foot Shoe Insert with Longitudinal Arch and Toe Filler

HCPCS-L5010-PARTIAL-FOOT-MOLDED-SOCKET-ANKLE-HEIGHT-TOE-FILLER

HCPCS L5010: Partial Foot Molded Socket, Ankle Height, with Toe Filler

HCPCS-L5020-PARTIAL-FOOT-MOLDED-SOCKET-TIBIAL-TUBERCLE-TOE-FILLER

HCPCS L5020: Partial Foot Molded Socket with Tibial Tubercle and Toe Filler

HCPCS-L5050-ANKLE-SYMES-MOLDED-SOCKET-SACH-FOOT

HCPCS L5050: Ankle Symes Molded Socket with SACH Foot

HCPCS-L5060-ANKLE-SYMES-METAL-FRAME-MOLDED-LEATHER-SOCKET-ARTICULATED-ANKLE-FOOT

HCPCS L5060: Ankle/Symes Prosthesis, Metal Frame with Molded Leather Socket, Articulated Ankle/Foot

HCPCS-L5100-BELOW-KNEE-MOLDED-SOCKET-SHIN-SACH-FOOT

HCPCS L5100: Below-Knee Molded Socket with Shin and SACH Foot

HCPCS-L5105-BELOW-KNEE-PLASTIC-SOCKET-SACH-FOOT

HCPCS L5105: Below-Knee Plastic Socket with Joints and SACH Foot

HCPCS-L5150-KNEE-DISARTICULATION-MOLDED-SOCKET-EXTERNAL-KNEE-SACH-FOOT

HCPCS L5150: Knee Disarticulation Prosthesis with Molded Socket and SACH Foot

HCPCS-L5200-ABOVE-KNEE-MOLDED-SOCKET-SINGLE-AXIS-KNEE-SACH-FOOT

HCPCS Level II L5200: Above-Knee Prosthesis with Single-Axis Knee

HCPCS-L5210-ABOVE-KNEE-SHORT-PROSTHESIS-STUBBIES

HCPCS L5210: Above-Knee Short Prosthesis Without Knee Joint

Showing 1–10 of 472

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier used (default)	Applied when no specific modifier is required or applicable.
`11`	Professional Component	Use when billing only the clinician’s professional component of a service related to prosthetic fitting or adjustments when split components are reportable.
`22`	Increased Procedural Services	Use when work required is substantially greater than typical (extensive revisions or complex fittings).
`52`	Reduced Services	Use when a service is partially reduced or not completed as originally planned (limited prosthetic fabrication).
`53`	Discontinued Procedure	Use when the prosthetic fabrication or fitting is started but discontinued due to patient condition.
`54`	Surgical Care Only	Use by a surgeon when billing only the surgical portion if separate prosthetic services are billed by another provider.
`55`	Postoperative Management Only	Use when billing only post-op care related to the amputation and not the surgical procedure.
`62`	Two Surgeons	Use if two surgeons of different specialties perform distinct portions of the amputation.
`78`	Unplanned Return to OR	Use for an unplanned return to the operating room for related revision or complication within the global period.
`80`	Assistant Surgeon	Use when an assistant surgeon provides services during the amputation.
`82`	Assistant Surgeon (when qualified resident unavailable)	Use when an assistant surgeon is needed and a qualified resident is not available.
`AS`	Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Medicare	Use when services are furnished by these clinicians under Medicare rules.
`QK`	Medical Direction of Two, Three, or Four Auxiliaries	Use when the clinician medically directs multiple qualified assistants in prosthetic-related services.

Taxonomy Code	Specialty	Notes
`174500000X`	Orthopedic Surgery	Primary surgical specialty performing amputations and residual limb management.
`366A00000X`	Physical Medicine & Rehabilitation	Provides pre- and post-prosthetic rehabilitation and functional assessments.
`225100000X`	Prosthetics & Orthotics	Certified prosthetists who fabricate, fit, and align the molded socket, external knee joints, and SACH foot.
`207L00000X`	Vascular Surgery	Manages peripheral arterial disease and vascular indications leading to knee disarticulation.
`208M00000X`	General Surgery	May perform amputations in certain settings and coordinate surgical care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.239`	Atherosclerosis of native arteries of extremities, unspecified extremity, with ulceration	Peripheral arterial disease with tissue loss can lead to nonhealing wounds necessitating knee disarticulation.
`I70.241`	Atherosclerosis of native arteries of right leg with ulceration	Side-specific PAD causing limb-threatening ischemia and infection prompting amputation.
`L97.322`	Non-pressure chronic ulcer of right calf with necrosis of muscle	Chronic infected ulcer with deep tissue involvement that may require amputation.
`T84.84XA`	Infection and inflammatory reaction due to internal prosthetic device, implant and graft, initial encounter	Deep infection complicating prior hardware or implants that necessitates limb removal and prosthetic planning.
`C79.51`	Secondary malignant neoplasm of bone	Tumor involving distal femur or knee region requiring through-knee amputation for local control.
`M86.172`	Chronic osteomyelitis, right femur	Chronic bone infection that is refractory to conservative treatment and leads to knee disarticulation.
`G62.0`	Diabetic polyneuropathy	Diabetes-related neuropathy contributing to foot/leg ulceration and infection ultimately leading to amputation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27590`	Revision of amputation stump, femur or knee; major reconstruction	Used for surgical revision of residual limb after knee disarticulation when major stump reconstruction is required.
`29999`	Unlisted procedure, arthroscopy or laparoscopic procedures (example placeholder for unlisted lower extremity prosthetic-related surgical procedures)	Occasionally used when a specific CPT descriptor for a unique prosthetic-related surgical procedure is not available; requires operative report.
`97760`	Orthotic(s) management and training, initial encounter for fitting and training; lower extremity, single limb, manual or mechanical	Used for initial prosthetic training and gait training after fitting the molded socket and components.
`97763`	Orthotic(s)/prosthetic(s) training, gait training (includes stair climbing)	Used for ongoing prosthetic gait training sessions following delivery and alignment of the prosthesis.
`99455`	Work-related or medical disability examination (to determine eligibility for prosthesis)	Used when documenting functional capacity evaluations or disability assessments needed for prosthetic authorization.

HCPCS L5000: Partial Foot Shoe Insert with Longitudinal Arch and Toe Filler

HCPCS-L5010-PARTIAL-FOOT-MOLDED-SOCKET-ANKLE-HEIGHT-TOE-FILLER

HCPCS L5010: Partial Foot Molded Socket, Ankle Height, with Toe Filler

HCPCS-L5020-PARTIAL-FOOT-MOLDED-SOCKET-TIBIAL-TUBERCLE-TOE-FILLER

HCPCS L5020: Partial Foot Molded Socket with Tibial Tubercle and Toe Filler

HCPCS-L5050-ANKLE-SYMES-MOLDED-SOCKET-SACH-FOOT

HCPCS L5050: Ankle Symes Molded Socket with SACH Foot

HCPCS-L5060-ANKLE-SYMES-METAL-FRAME-MOLDED-LEATHER-SOCKET-ARTICULATED-ANKLE-FOOT

HCPCS L5060: Ankle/Symes Prosthesis, Metal Frame with Molded Leather Socket, Articulated Ankle/Foot

HCPCS-L5100-BELOW-KNEE-MOLDED-SOCKET-SHIN-SACH-FOOT

HCPCS L5100: Below-Knee Molded Socket with Shin and SACH Foot

HCPCS-L5105-BELOW-KNEE-PLASTIC-SOCKET-SACH-FOOT

HCPCS L5105: Below-Knee Plastic Socket with Joints and SACH Foot

HCPCS-L5150-KNEE-DISARTICULATION-MOLDED-SOCKET-EXTERNAL-KNEE-SACH-FOOT

HCPCS L5150: Knee Disarticulation Prosthesis with Molded Socket and SACH Foot

HCPCS-L5200-ABOVE-KNEE-MOLDED-SOCKET-SINGLE-AXIS-KNEE-SACH-FOOT

HCPCS Level II L5200: Above-Knee Prosthesis with Single-Axis Knee

HCPCS-L5210-ABOVE-KNEE-SHORT-PROSTHESIS-STUBBIES

HCPCS L5210: Above-Knee Short Prosthesis Without Knee Joint

Showing 1–10 of 472

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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HCPCS L5160: Knee Disarticulation Molded Socket with Bent Knee and SACH Foot

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Billing Code Overview

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HCPCS L5160: Knee Disarticulation Molded Socket with Bent Knee and SACH Foot

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

HCPCS L5160: Knee Disarticulation Molded Socket with Bent Knee and SACH Foot

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Billing Code Overview

HCPCS L5160: Knee Disarticulation Molded Socket with Bent Knee and SACH Foot

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does HCPCS L5160 cover and where is this prosthesis typically provided?

Which clinician specialties are commonly involved in care and billing for L5160?

What preoperative and postoperative services and related CPT codes are referenced for patients receiving L5160?

Which modifiers are noted as potentially applicable when billing for L5160?

What diagnoses are commonly associated with L5160 and which payers are listed as covering this code?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does HCPCS L5160 cover and where is this prosthesis typically provided?

Which clinician specialties are commonly involved in care and billing for L5160?

What preoperative and postoperative services and related CPT codes are referenced for patients receiving L5160?

Which modifiers are noted as potentially applicable when billing for L5160?

What diagnoses are commonly associated with L5160 and which payers are listed as covering this code?

References