HCPCS Level II L5694: Addition to Lower Extremity, Above-Knee Pelvic Control Belt

HCPCS Level II code L5694 describes an addition to a lower extremity prosthetic providing above-knee pelvic control with a padded and lined belt; the service is a prosthetic component used to enhance socket suspension and pelvic stabilization for transfemoral prostheses and is typically delivered in an outpatient prosthetics/orthotics clinic or specialty durable medical equipment setting.

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HCPCS Level II L5694: Addition to Lower Extremity, Above-Knee Pelvic Control Belt

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Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with an above-knee amputation who requires an additional pelvic control belt padded and lined (L5694) to improve suspension, coronal stability, and comfort of a transfemoral prosthesis. The patient presents to a prosthetics clinic after initial socket fitting with complaints of pelvic instability, lateral drifting of the prosthesis during gait, and localized skin irritation from socket movement. The prosthetist performs a physical examination, observes gait deviations consistent with poor pelvic control, reviews prior prosthetic components, and documents functional goals (improved balance, decreased skin shear, and safer community ambulation).

The clinical workflow includes evaluation by a certified prosthetist, measurement and ordering of the pelvic control belt addition (L5694), selection of padding and lining materials to reduce pressure points, fabrication or modification in the prosthetics lab, fitting session with donning/doffing training, and a follow-up visit to assess fit, skin integrity, and gait. Billing uses HCPCS Level II code L5694 with appropriate modifiers to indicate laterality, provider relationship, or unusual circumstances. Common payors for authorization and claims adjudication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97760`	Orthotic management and training, initial encounter; first orthosis, lower extremity, with training of patient in use	Used for training patient in donning/doffing and functional use of the pelvic control belt addition
`97761`	Prosthetic training, upper and/or lower extremity, initial encounter	Used for prosthetic gait training sessions following fitting of the pelvic control belt addition
`97763`	Orthotic/prosthetic management and evaluation with training, subsequent encounter	Used for follow-up adjustments, fitting checks, and continued training after initial provision
`99070`	Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or other services rendered	Used for billing nonstandard padding or lining materials when payor allows separate supply billing
`S1040`	Prosthetic device/supplies, lower limb, pelvic belt/hip belt, addition	Supplemental HCPCS-level or local code sometimes used by payors in conjunction with `L5694` for detailed billing reconciliation

Related Modifiers

6 rows

Modifier	Description	When to Use
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
2080P0205X	Pediatric Endocrinology Physician	A pediatrician who provides expert care to infants, children and adolescents who have diseases that result from an abnormality in the endocrine glands…
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
207ZH0000X	Hematology (Pathology) Physician	A hematopathologist is expert in diseases that affect blood cells, blood clotting mechanisms, bone marrow and lymph nodes. This physician has the know…
126900000X	Dental Laboratory Technician	An individual who has the skill and knowledge in the fabrication of dental appliances, prostheses and devices in accordance with a dentist's laborator…
163WH0200X	Home Health Registered Nurse	Nursing Service Providers · Registered Nurse
335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier	A supplier that provides one or more of the following portable services, including but not limited to, x-ray, electrocardiogram (EKG), long-term EKG (…
2080P0008X	Pediatric Neurodevelopmental Disabilities Physician	A pediatrician who specializes in the treatment of individuals with developmental delays and learning disorders associated with cerebral palsy, spina …
246QC1000X	Chemistry Pathology Specialist/Technologist	Technologists, Technicians & Other Technical Service Providers · Specialist/Technologist, Pathology

Related ICD-10-CM Codes

24 rows

ICD-10-CM Code	Description
G82.20	Paraplegia, unspecified
G82.21	Paraplegia, complete
M16.11	Unilateral primary osteoarthritis, right hip
M16.12	Unilateral primary osteoarthritis, left hip
M17.0	Bilateral primary osteoarthritis of knee
M17.11	Unilateral primary osteoarthritis, right knee
M17.12	Unilateral primary osteoarthritis, left knee
M17.9	Osteoarthritis of knee, unspecified
M24.271	Disorder of ligament, right ankle
M25.561	Pain in right knee

Showing 1–10 of 24

HCPCS Level II L5000: Partial Foot Shoe Insert with Longitudinal Arch, 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 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 Metal Frame with Molded Leather Socket

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

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

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

HCPCS L5105: Below-Knee Plastic Socket Prosthesis with SACH Foot

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

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

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

HCPCS Level II L5160: Knee Disarticulation Molded Socket, Bent Knee Configuration

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

HCPCS Level II L5200: Above-knee Prosthesis with Molded Socket and Single-axis Knee

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

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97760`	Orthotic management and training, initial encounter; first orthosis, lower extremity, with training of patient in use	Used for training patient in donning/doffing and functional use of the pelvic control belt addition
`97761`	Prosthetic training, upper and/or lower extremity, initial encounter	Used for prosthetic gait training sessions following fitting of the pelvic control belt addition
`97763`	Orthotic/prosthetic management and evaluation with training, subsequent encounter	Used for follow-up adjustments, fitting checks, and continued training after initial provision
`99070`	Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or other services rendered	Used for billing nonstandard padding or lining materials when payor allows separate supply billing
`S1040`	Prosthetic device/supplies, lower limb, pelvic belt/hip belt, addition	Supplemental HCPCS-level or local code sometimes used by payors in conjunction with `L5694` for detailed billing reconciliation

Related Modifiers

6 rows

Modifier	Description	When to Use
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
2080P0205X	Pediatric Endocrinology Physician	A pediatrician who provides expert care to infants, children and adolescents who have diseases that result from an abnormality in the endocrine glands…
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
207ZH0000X	Hematology (Pathology) Physician	A hematopathologist is expert in diseases that affect blood cells, blood clotting mechanisms, bone marrow and lymph nodes. This physician has the know…
126900000X	Dental Laboratory Technician	An individual who has the skill and knowledge in the fabrication of dental appliances, prostheses and devices in accordance with a dentist's laborator…
163WH0200X	Home Health Registered Nurse	Nursing Service Providers · Registered Nurse
335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier	A supplier that provides one or more of the following portable services, including but not limited to, x-ray, electrocardiogram (EKG), long-term EKG (…
2080P0008X	Pediatric Neurodevelopmental Disabilities Physician	A pediatrician who specializes in the treatment of individuals with developmental delays and learning disorders associated with cerebral palsy, spina …
246QC1000X	Chemistry Pathology Specialist/Technologist	Technologists, Technicians & Other Technical Service Providers · Specialist/Technologist, Pathology

Related ICD-10-CM Codes

24 rows

ICD-10-CM Code	Description
G82.20	Paraplegia, unspecified
G82.21	Paraplegia, complete
M16.11	Unilateral primary osteoarthritis, right hip
M16.12	Unilateral primary osteoarthritis, left hip
M17.0	Bilateral primary osteoarthritis of knee
M17.11	Unilateral primary osteoarthritis, right knee
M17.12	Unilateral primary osteoarthritis, left knee
M17.9	Osteoarthritis of knee, unspecified
M24.271	Disorder of ligament, right ankle
M25.561	Pain in right knee

Showing 1–10 of 24

HCPCS Level II L5000: Partial Foot Shoe Insert with Longitudinal Arch, 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 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 Metal Frame with Molded Leather Socket

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

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

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

HCPCS L5105: Below-Knee Plastic Socket Prosthesis with SACH Foot

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

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

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

HCPCS Level II L5160: Knee Disarticulation Molded Socket, Bent Knee Configuration

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

HCPCS Level II L5200: Above-knee Prosthesis with Molded Socket and Single-axis Knee

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

OpenPayer

HCPCS Level II L5694: Addition to Lower Extremity, Above-Knee Pelvic Control Belt

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HCPCS Level II L5694: Addition to Lower Extremity, Above-Knee Pelvic Control Belt

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

References

HCPCS Level II L5694: Addition to Lower Extremity, Above-Knee Pelvic Control Belt

Sign up for hcpcs L5694 policy alerts

HCPCS Level II L5694: Addition to Lower Extremity, Above-Knee Pelvic Control Belt

Sign up for hcpcs L5694 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What does HCPCS code L5694 represent and where is it typically provided?

Which modifiers should I consider when billing L5694?

What clinical documentation and workflow elements support billing L5694?

Which related CPT/HCPCS codes might be billed alongside L5694?

Which ICD‑10 diagnosis codes are commonly associated with L5694 claims?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What does HCPCS code L5694 represent and where is it typically provided?

Which modifiers should I consider when billing L5694?

What clinical documentation and workflow elements support billing L5694?

Which related CPT/HCPCS codes might be billed alongside L5694?

Which ICD‑10 diagnosis codes are commonly associated with L5694 claims?

References