Summary & Overview
HCPCS L5702: Replacement Hip Disarticulation Socket, Molded to Patient Model
HCPCS Level II code L5702 represents a replacement, custom-molded socket for a hip disarticulation prosthesis that includes the hip joint. This code captures a high-cost, specialized prosthetic component used for patients who have undergone hip disarticulation and require a precisely fitted socket to support mobility and function. Nationally, accurate coding for such devices is important for payment integrity, patient access to custom prosthetics, and appropriate clinical documentation.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks for coverage and reimbursement practices across major commercial payers and Medicare, summaries of typical sites of service and clinical context, and guidance on documentation elements that are commonly required for medical necessity determinations. The publication also highlights common billing modifiers and areas where policy variation often occurs, such as replacement frequency and custom fabrication justification.
This summary is intended to give clinicians, billing professionals, and policy analysts a concise overview of what L5702 signifies, why precise reporting matters, and what to expect when submitting claims for a custom-molded hip disarticulation socket with integrated hip joint. Data not available in the input.
Billing Code Overview
HCPCS Level II code L5702 describes a replacement socket for a hip disarticulation prosthesis, including the hip joint, molded to a patient model. This item is a custom-fabricated prosthetic component designed to fit a patient who has undergone hip disarticulation.
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Service type: Prosthetic replacement component, custom-molded socket with integrated hip joint
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Typical site of service: Orthotics and prosthetics clinic or specialty prosthetics fabrication facility
Clinical & Coding Specifications
Clinical Context
A 62-year-old male patient with a prior oncologic hip girdle resection presents for fabrication and fitting of a replacement prosthetic socket following a hip disarticulation. The patient has a healed surgical site, stable skin and soft tissues, and has completed initial postoperative wound care and prosthetic readiness evaluation by the prosthetist and rehabilitation team. Pre-prosthetic assessment includes a gait and mobility evaluation by physical therapy, residual limb measurement and molding to a patient-specific model by the prosthetist, and review of comorbidities (for example, peripheral vascular disease, diabetes) with the supervising physician.
The clinical workflow proceeds as follows: initial prosthetic evaluation and documentation of functional goals; creation of a positive model from a cast or digital scan of the hemipelvectomy/hip disarticulation residual anatomy; fabrication of a socket and integration of the hip joint component molded to the patient model; iterative fitting visits for alignment and pressure mapping; adjustments for comfort and function; and final delivery with documentation of functional outcome measures and device components. Typical sites of service include outpatient prosthetics clinics, orthotics and prosthetics offices, and specialized rehabilitation centers. The service type is a durable medical equipment/prosthetic device provision and fitting service specific to a hip disarticulation socket replacement (L5702).
Coding Specifications
| Modifier | Description | When to Use |
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