HCPCS L5595: Preparatory Pylon for Hip Disarticulation/Hemipelvectomy - OpenPayer

Summary & Overview

HCPCS L5595: Preparatory Pylon for Hip Disarticulation/Hemipelvectomy

HCPCS Level II code L5595 denotes a preparatory prosthetic assembly for patients following hip disarticulation or hemipelvectomy. The device is a thermoplastic, patient-molded pylon without cover, fitted with a SACH (solid ankle cushion heel) foot. This code is relevant nationally for prosthetic manufacturers, orthotic and prosthetic (O&P) providers, hospital billing departments, and payers managing high-acuity limb-loss care because it captures a specialized preparatory appliance used prior to definitive prosthetic fittings.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for L5595, typical sites of service, and which stakeholders commonly use the code. The publication also summarizes benchmarking and reimbursement context where available, notes common modifiers, and highlights policy and coverage considerations that affect billing for high-level lower-extremity amputations. The content aims to equip billing managers, prosthetists, and policy analysts with concise information on coding intent, service classification, and payer relevance for L5595 at a national level.

Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and detailed payer-specific coverage rules.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareL5595HCPCS Level IIprostheticship disarticulationhemipelvectomypylonSACH footthermoplasticoutpatient prosthetics

Billing Code Overview

HCPCS Level II code L5595 describes a preparatory prosthetic component intended for patients undergoing hip disarticulation or hemipelvectomy. The item is specified as a pylon without cover, fitted with a SACH foot, constructed from thermoplastic or equivalent, and molded to a patient model.

Service type: Prosthetic preparatory device

Typical site of service: Orthotics and prosthetics clinic, outpatient prosthetics facility, or hospital prosthetics department

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with a history of recurrent malignant musculoskeletal tumor of the proximal femur and pelvic girdle undergoes planning and fabrication of a preparatory prosthetic pylon following a hip disarticulation or hemipelvectomy. The prosthetic device described by L5595 is a molded thermoplastic preparatory (prosthetic) pylon for a hip disarticulation/hemipelvectomy level, designed with no cosmetic cover and fitted with a SACH foot. Clinical workflow begins with an interdisciplinary evaluation by an orthotist and the surgical/rehabilitation team, including review of the operative report, residual limb characteristics, and goals of mobility. A patient model (cast or digital scan) is created in the orthotics lab; the preparatory pylon is fabricated and trialed for fit, alignment, and weight-bearing tolerance during follow-up visits. Typical care settings include outpatient prosthetics/orthotics clinics, inpatient rehabilitation facilities, and hospital-based prosthetics services immediately post-amputation or in the subacute period for staged fitting. The device supports early mobility, gait training, and progressive weight-bearing while definitive prosthesis design is planned.

Coding Specifications

Modifier	Description	When to Use
`59`	Data not available in the input.	Data not available in the input.

HCPCS L8410: Prosthetic Sheath, Above Knee, Each

HCPCS-L8600-IMPLANTABLE-BREAST-PROSTHESIS-SILICONE

HCPCS Level II L8600: Implantable Breast Prosthesis, Silicone or Equal

HCPCS-L7261-ELECTRONIC-WRIST-ROTATOR-UTAH-ARM

HCPCS L7261: Electronic Wrist Rotator for Utah Arm

HCPCS-L8691-AUDITORY-OSSEOINTEGRATED-EXTERNAL-SOUND-PROCESSOR-REPLACEMENT

HCPCS L8691: Auditory Osseointegrated External Sound Processor, Replacement Only

HCPCS-L5985-ENDOSKELETAL-LOWER-EXTREMITY-DYNAMIC-PYLON

HCPCS L5985: Endoskeletal Lower Extremity Prosthesis, Dynamic Pylon

HCPCS-L5655-BELOW-KNEE-SOCKET-INSERT-PROSTHETIC-ADDITION

HCPCS L5655: Below-Knee Prosthetic Socket Insert

HCPCS-L5270-HIP-DISARTICULATION-TILT-TABLE-MOLDED-SOCKET-LOCKING-HIP

HCPCS L5270: Hip Disarticulation Tilt-Table Prosthetic Assembly

HCPCS-L5986-LOWER-EXTREMITY-PROSTHESIS-MULTI-AXIAL-ROTATION-UNIT

HCPCS L5986: Lower Extremity Prosthesis, Multi-Axial Rotation Unit

HCPCS-L5858-LOWER-EXTREMITY-PROSTHESIS-MICROPROCESSOR-STANCE-KNEE-SHIN

HCPCS L5858: Lower Extremity Prosthesis, Microprocessor Stance-Phase Knee-Shin

HCPCS-L5636-LOWER-EXTREMITY-SYMES-MEDIAL-OPENING-SOCKET

HCPCS L5636: Lower Extremity Symes Medial Opening Socket

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Taxonomy Code	Specialty	Notes
`2285S0002X`	Orthotics and Prosthetics	Primary specialty providing device measurement, fitting, and fabrication for `L5595`.
`208M00000X`	Physical Medicine & Rehabilitation	Manages rehabilitation, gait training, and functional goals following hip disarticulation/hemipelvectomy.
`2080P0200X`	Orthopedic Surgery	Performs the amputation/hemipelvectomy and coordinates surgical planning with prosthetic needs.
`208000000X`	Physical Therapist	Provides mobility training, prosthetic training, and functional outcome assessment.
`363L00000X`	Hospitalist	Coordinates inpatient perioperative and medical care that influences prosthetic timing.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C40.0`	Malignant neoplasm of bones of skull and face	Representative of malignant bone disease that may necessitate high-level amputation or hemipelvectomy and subsequent preparatory prosthesis.
`C41.4`	Malignant neoplasm of pelvic bones, sacrum and coccyx	Tumors in the pelvic region often require hemipelvectomy with need for hip-disarticulation-level prosthetic planning.
`M86.20`	Osteomyelitis, pelvis, unspecified	Severe infection of the pelvis that can lead to amputation and the need for preparatory prosthetic devices.
`T79.A11`	Traumatic amputation of left lower leg at hip level	Trauma-related hip disarticulation indications requiring prosthetic provision and preparatory pylons.
`Z48.21`	Encounter for aftercare following joint replacement surgery	Used for post-amputation/aftercare encounters related to prosthetic fitting and rehabilitation.
`Z44.31`	Encounter for fitting and adjustment of right artificial leg	Specific code for prosthetic fitting encounters directly relevant to `L5595` use.
`Z43.1`	Encounter for fitting and adjustment of external prosthetic device	General aftercare code used for prosthetic fitting and adjustments post-amputation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97760`	Orthotic(s) management and training, upper extremity, lower extremity, and/or trunk, initial orthotic fit; requiring multiple visits for training and adjustment	Used for patient training and multiple visits required after fitting the preparatory pylon to optimize function and alignment.
`97762`	Checkout for orthotic/prosthetic use, established patient; prosthetic check	Applied for follow-up checks of the preparatory prosthesis, adjustments, and gait assessment.
`99070`	Supplies and materials (except spectacles), provided by physician or other qualified health care professional over and above those usually included with the office visit	Billed for additional non-standard supplies or components used in fabrication or adjustments not included in base device pricing.
`99455`	Work related or medical disability examination services (by employer request)	May be used when functional capacity evaluations related to prosthetic rehabilitation are requested for disability/work clearance.
`97750`	Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report, each test	Used for baseline and post-fit functional assessments relevant to mobility with the preparatory pylon.

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