Summary & Overview
HCPCS Level II L5707: Custom Shaped Protective Cover, Hip Disarticulation
HCPCS Level II code L5707 denotes a custom shaped protective cover for patients with hip disarticulation amputations. This code captures supply and fabrication of a device tailored to the unique anatomic and prosthetic contours of a hip disarticulation residual limb. Nationally, codes for custom protective devices are important for accurate billing, clinical documentation, and ensuring access to appropriate prosthetic and post-amputation protective equipment.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical context, typical sites of service, and the payer landscape relevant to coverage and claims processing. The publication summarizes common modifiers and billing considerations, outlines typical clinical indications tied to hip disarticulation care, and highlights where readers can expect variability in coverage and reimbursement practice.
This guide is intended for billing professionals, prosthetists, orthotists, and policy analysts seeking a concise reference to code L5707, its clinical use, and the national payer context for custom protective devices used after hip disarticulation.
Billing Code Overview
HCPCS Level II code L5707 describes a custom shaped protective cover specifically designed for patients with hip disarticulation. The product represented by this code is a customized protective device shaped to accommodate the anatomic and prosthetic needs of a hip disarticulation amputation.
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Service type: Custom protective device fabrication and supply
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Typical site of service: Orthotic/prosthetic clinic, durable medical equipment supplier, or outpatient rehabilitation setting
Clinical & Coding Specifications
Clinical Context
A patient who has undergone a hip disarticulation (surgical removal of the lower limb through the hip joint) presents for custom prosthetic interface and protective coverage fabrication. Typical patients include those with traumatic high-level amputation, malignant tumor resection involving the proximal femur and pelvis, severe infection or necrosis requiring hip disarticulation, or congenital limb deficiency when surgical revision creates a high-level residual limb. The clinical workflow includes: pre-prosthetic evaluation by a physiatrist or prosthetist to assess residual limb shape, skin integrity, and pelvic stability; measurement and cast or digital scan of the residual limb and pelvis to capture contours for a L5707 custom shaped protective cover for the hip disarticulation; fabrication in an orthotics/prosthetics lab with iterative fitting; in-clinic fitting and adjustments by the prosthetist; and follow-up visits for pressure-area checks, cushion/lining adjustments, and functional training with physical therapy. Typical site of service is an outpatient prosthetics/orthotics clinic, specialized rehabilitation facility, or hospital-based prosthetics department. Typical modifiers applied reflect professional vs facility billing, bilateral involvement if applicable to pelvic/contralateral procedures, and circumstances such as reduced services or unusual procedural complexity.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Presumptive, usually standard modifier for initial procedure |