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

HCPCS Level II code L5200 denotes an above-knee prosthetic assembly composed of a molded socket, a single-axis constant friction knee, a shin component, and a SACH foot. This code identifies a basic mechanical transfemoral prosthesis designed to restore limited ambulation and basic functional mobility for individuals with above-knee amputations. Nationally, L5200 is relevant for coverage determinations, device selection, and durable medical equipment (DME) billing workflows.

Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of billing and coding context for L5200, typical care settings and service types, and the common clinical scenarios in which this prosthetic assembly is used. The publication summarizes payer coverage considerations and benchmarking context where available, highlights policy and documentation elements that affect claim adjudication, and outlines coding relationships for prosthetic service lines.

This summary provides clinicians, prosthetists, revenue cycle staff, and policy analysts with a concise reference to the clinical role of L5200, its placement within prosthetic service delivery, and the payer landscape that commonly governs reimbursement and utilization decisions.

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Billing Code Overview

HCPCS Level II code L5200 describes an above knee prosthesis with a molded socket, single axis constant friction knee, shin, and sach foot. This item represents a lower-extremity prosthetic assembly intended to replace an above-knee amputation and provide basic ambulation function.

Service Type: Prosthetic device provision and fitting

Typical Site of Service: Outpatient prosthetics clinic or orthotics and prosthetics (O&P) facility, with fitting and adjustments commonly performed in clinical O&P settings.

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

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Billing Code Overview

Service Type: Prosthetic device provision and fitting

Typical Site of Service: Outpatient prosthetics clinic or orthotics and prosthetics (O&P) facility, with fitting and adjustments commonly performed in clinical O&P settings.

Clinical & Coding Specifications

Clinical Context

A 58-year-old male with a transtibial amputation that has progressed to an above-knee limb loss following a high-energy motorcycle crash is fitted for a definitive prosthesis. The prosthetic prescription is for an above-knee prosthesis with a molded socket, single-axis constant friction knee joint, and a SACH foot to provide stable, durable ambulation for community mobility. The clinical workflow begins with the prosthetist’s initial evaluation and measurement, followed by socket casting or digital scan, fabrication of the molded socket, integration of the single-axis constant friction knee mechanism, attachment of the SACH foot, alignment and dynamic alignment trial, gait training with a physical therapist, and final adjustments before delivery. Typical follow-up visits include socket comfort checks, minor alignment changes, and documentation of fit and function. The typical site of service is an outpatient prosthetics clinic or specialized orthotics and prosthetics facility. Key caregivers in the episode include a certified prosthetist, a physical therapist, and the referring orthopedic or vascular surgeon.

Coding Specifications

Modifier	Description	When to Use
`11`	Professional component	When billing the prosthetist’s professional services separately from technical fabrication (rare for prosthetics but used if allowed).
`22`	Increased procedural services	When additional work is required beyond typical fitting (complex shaping, extensive modifications).
`52`	Reduced services	When components or services are partially furnished (e.g., interim adjustments instead of full delivery).
`53`	Discontinued procedure	If fabrication or fitting is discontinued due to patient condition before completion.
`54`	Surgical care only	When a surgeon provides only perioperative care related to amputation and not the prosthetic fitting.
`55`	Postoperative management only	When only post-amputation rehabilitation or follow-up prosthetic adjustments are billed separately.
`62`	Two surgeons	Rarely used; when two qualified practitioners of different specialties share responsibility during a related surgical episode that affects prosthetic needs.
`78`	Return to operating room for related procedure	When a surgical revision impacts prosthetic interface and necessitates rebasing or refabrication.
`80`	Assistant surgeon	If an assistant surgeon’s role is billed during a related surgical procedure affecting limb status.
`AS`	Independent clinical laboratory	Not typically applicable to prosthetic billing; included if lab services are separately billed.
`CO`	Cast/other payer crossover	Use when crossover billing rules apply for coordination between payors.
`NU`	New equipment	To indicate new prosthetic device versus replacement.
`UE`	Upper extremity	Not applicable to this lower-extremity code; included only if miscoding risk needs clarification.

Taxonomy Code	Specialty	Notes
261QM1300X	Prosthetics & Orthotics	Certified prosthetist who evaluates, designs, and fits the device.
208800000X	Physical Therapy	Physical therapist who provides gait training and functional training.
207L00000X	Orthopedic Surgery	Surgeon responsible for amputation care and surgical follow-up impacting prosthetic management.
251S00000X	Rehabilitation Medicine (Physiatry)	Physiatrist overseeing prosthetic rehabilitation and functional goals.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z89.511`	Acquired absence of right leg above knee	Common reason for prescribing an above-knee prosthesis with a molded socket and knee joint.
`Z89.512`	Acquired absence of left leg above knee	Same clinical relevance for contralateral limb loss.
`S78.011A`	Complete traumatic amputation of right thigh, initial encounter	Traumatic etiology leading to need for an above-knee prosthesis.
`S78.012A`	Complete traumatic amputation of left thigh, initial encounter	Traumatic cause for above-knee prosthetic prescription.
`T79.A11A`	Traumatic amputation of right lower limb, initial encounter	Coded for acute traumatic amputation events requiring subsequent prosthetic rehabilitation.
`K55.0`	Acute vascular insufficiency of intestine (example vascular compromise)	Vascular disease can lead to limb ischemia and amputation; included when vascular etiology is documented.
`E11.52`	Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene	Diabetic complications are a frequent cause of major lower-extremity amputation and prosthetic need.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97760`	Orthotic/prosthetic management and training, initial fitting — lower extremity prosthesis, first visit	Commonly performed at delivery for gait training and patient education following placement of the above-knee prosthesis.
`97761`	Prosthetic training, subsequent prosthetic training, lower extremity	Used for follow-up training visits to advance mobility and function after initial fitting.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient	May be billed by the prosthetist, physiatrist, or surgeon for routine follow-up related to prosthetic issues.
`73560`	Radiologic examination, femur and hip, single view	Ordered occasionally to evaluate residual limb integrity or joint issues that affect prosthetic fitting (as clinically indicated).
`97763`	Orthotic/prosthetic management and training, subsequent prosthetic training, new prosthesis fitting (not commonly used for all payors)	Used in some settings for subsequent complex fitting sessions or device readjustments.

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-L5160-KNEE-DISARTICULATION-MOLDED-SOCKET-BENT-KNEE-SACH-FOOT

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

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
`11`	Professional component	When billing the prosthetist’s professional services separately from technical fabrication (rare for prosthetics but used if allowed).
`22`	Increased procedural services	When additional work is required beyond typical fitting (complex shaping, extensive modifications).
`52`	Reduced services	When components or services are partially furnished (e.g., interim adjustments instead of full delivery).
`53`	Discontinued procedure	If fabrication or fitting is discontinued due to patient condition before completion.
`54`	Surgical care only	When a surgeon provides only perioperative care related to amputation and not the prosthetic fitting.
`55`	Postoperative management only	When only post-amputation rehabilitation or follow-up prosthetic adjustments are billed separately.
`62`	Two surgeons	Rarely used; when two qualified practitioners of different specialties share responsibility during a related surgical episode that affects prosthetic needs.
`78`	Return to operating room for related procedure	When a surgical revision impacts prosthetic interface and necessitates rebasing or refabrication.
`80`	Assistant surgeon	If an assistant surgeon’s role is billed during a related surgical procedure affecting limb status.
`AS`	Independent clinical laboratory	Not typically applicable to prosthetic billing; included if lab services are separately billed.
`CO`	Cast/other payer crossover	Use when crossover billing rules apply for coordination between payors.
`NU`	New equipment	To indicate new prosthetic device versus replacement.
`UE`	Upper extremity	Not applicable to this lower-extremity code; included only if miscoding risk needs clarification.

Taxonomy Code	Specialty	Notes
261QM1300X	Prosthetics & Orthotics	Certified prosthetist who evaluates, designs, and fits the device.
208800000X	Physical Therapy	Physical therapist who provides gait training and functional training.
207L00000X	Orthopedic Surgery	Surgeon responsible for amputation care and surgical follow-up impacting prosthetic management.
251S00000X	Rehabilitation Medicine (Physiatry)	Physiatrist overseeing prosthetic rehabilitation and functional goals.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z89.511`	Acquired absence of right leg above knee	Common reason for prescribing an above-knee prosthesis with a molded socket and knee joint.
`Z89.512`	Acquired absence of left leg above knee	Same clinical relevance for contralateral limb loss.
`S78.011A`	Complete traumatic amputation of right thigh, initial encounter	Traumatic etiology leading to need for an above-knee prosthesis.
`S78.012A`	Complete traumatic amputation of left thigh, initial encounter	Traumatic cause for above-knee prosthetic prescription.
`T79.A11A`	Traumatic amputation of right lower limb, initial encounter	Coded for acute traumatic amputation events requiring subsequent prosthetic rehabilitation.
`K55.0`	Acute vascular insufficiency of intestine (example vascular compromise)	Vascular disease can lead to limb ischemia and amputation; included when vascular etiology is documented.
`E11.52`	Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene	Diabetic complications are a frequent cause of major lower-extremity amputation and prosthetic need.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97760`	Orthotic/prosthetic management and training, initial fitting — lower extremity prosthesis, first visit	Commonly performed at delivery for gait training and patient education following placement of the above-knee prosthesis.
`97761`	Prosthetic training, subsequent prosthetic training, lower extremity	Used for follow-up training visits to advance mobility and function after initial fitting.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient	May be billed by the prosthetist, physiatrist, or surgeon for routine follow-up related to prosthetic issues.
`73560`	Radiologic examination, femur and hip, single view	Ordered occasionally to evaluate residual limb integrity or joint issues that affect prosthetic fitting (as clinically indicated).
`97763`	Orthotic/prosthetic management and training, subsequent prosthetic training, new prosthesis fitting (not commonly used for all payors)	Used in some settings for subsequent complex fitting sessions or device readjustments.

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-L5160-KNEE-DISARTICULATION-MOLDED-SOCKET-BENT-KNEE-SACH-FOOT

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

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.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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

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Billing Code Overview

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

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

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Billing Code Overview

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

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does HCPCS code L5200 represent?

Where and how is the L5200 prosthesis typically delivered and followed up?

Which related CPT codes are relevant when billing services associated with L5200?

What modifiers are relevant to billing L5200 and when are they used?

Which clinical specialties and payers are most relevant for L5200 claims and care coordination?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does HCPCS code L5200 represent?

Where and how is the L5200 prosthesis typically delivered and followed up?

Which related CPT codes are relevant when billing services associated with L5200?

What modifiers are relevant to billing L5200 and when are they used?

Which clinical specialties and payers are most relevant for L5200 claims and care coordination?

References