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    v1.0.31
    OpenPayerBilling CodesProsthetic ProceduresHCPCS hcpcs-l5960-endoskeletal-hip-disarticulation-ultra-light-addition
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    HCPCS L5960: Addition, Endoskeletal Hip Disarticulation, Ultra-Light Material

    HCPCS Level II code L5960 describes an addition to an endoskeletal prosthetic system for hip disarticulation constructed from ultra-light materials such as titanium or carbon fiber; the service is a prosthetic component addition (endoskeletal system) intended for use in prosthetic fitting and mobility restoration, typically provided in prosthetics clinics or outpatient orthopedic/prosthetics settings.

    For related coverage guidance, see recent payer policy updates: Speech Therapy for Autism Disorders - Medical Policy, Physical Performance Test or Measurement, Sensory Integration Therapy and Auditory Integration Training.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult with a proximal lower‑extremity amputation at the hip disarticulation level requiring an endoskeletal prosthetic restoration constructed from ultra‑light materials such as titanium or carbon fiber. The clinical workflow begins with a prosthetist and orthotist evaluation following surgical healing and residual limb maturation. The prosthesis prescription is based on functional goals (household, community ambulation, or wheelchair mobility), limb shape, and patient comorbidities. Measurement, casting or digital scanning, and template fabrication are followed by a test socket fitting, alignment and gait training sessions, and iterative adjustments. The addition described by L5960 is applied to the prosthetic socket/pylon assembly of a hip disarticulation prosthesis to provide a lightweight endoskeletal component to improve comfort and reduce energy expenditure during use. Typical sites of service include outpatient prosthetics/orthotics clinics, specialized rehabilitation hospitals, and ambulatory surgery centers for component fittings; inpatient rehabilitation units and long‑term acute care facilities may also be involved for medically complex patients.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    97760Orthotic(s) management and training; initial encounter, each 15 minutesUsed for patient training in use of the hip disarticulation prosthesis after fitting
    97763Orthotic/prosthetic management and training, upper/lower extremity, initial encounterProvides billable therapy time for prosthetic training and gait rehabilitation
    99070Supplies and materials (except spectacles) provided by the physician over and above those usually included with the office visitMay be used for miscellaneous non‑standard supplies associated with fitting prosthetic components
    P8540Prosthesis, lower limb, hip-disarticulation, with socket, adjustable or flexible, endoskeletal (example descriptor)Representative code for the primary prosthesis; relates to addition L5960 as a component modification
    L4360Foot, replacement, below-knee, silicone interface (example L-code)Example of adjunct L-code items for other levels; included to demonstrate component-based billing alongside L5960

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT 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…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…
    22Modifier –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…
    52Modifier ‑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…
    53Modifier 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…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    231H00000X
    207L00000X
    207P00000X
    3336C0002X
    208VP0000X
    163WX0200X
    305S00000X
    246XC2901X

    Related ICD-10-CM Codes

    23 rows

    ICD-10-CM CodeDescription
    G54.6Phantom limb syndrome with pain
    M16.11Unilateral primary osteoarthritis, right hip
    M16.12Unilateral primary osteoarthritis, left hip
    M16.9Osteoarthritis of hip, unspecified
    M24.561Contracture, right knee
    M24.562Contracture, left knee
    M84.351AStress fracture, right femur, initial encounter for fracture
    M84.352AStress fracture, left femur, initial encounter for fracture
    M84.359AStress fracture, hip, unspecified, initial encounter for fracture
    M84.361AStress fracture, right tibia, initial encounter for fracture

    Showing 1–10 of 23

    Related Payer Policy Updates

    Specialty: Physical Medicine, Rehab & Therapies1 / 2

    10 rows

    PolicyPayerEffective Date
    Speech Therapy for Autism Disorders - Medical PolicyHealth-New-England2026-12-01
    Physical Performance Test or MeasurementCigna2026-11-15
    Sensory Integration Therapy and Auditory Integration TrainingColorado Rocky Mountain Health Plans2026-11-01
    Skilled Nursing and Skilled Rehabilitation Services (Outpatient)Anthem2026-10-01
    Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for New Mexico Only)UnitedHealthcare2026-10-01
    Physical Therapy/Medicine Corporate Medical Policybcbsvermont2026-10-01
    Cognitive Rehabilitation Corporate Medical Policybcbsvermont2026-10-01
    Speech Language Pathology/Therapy Services Corporate Medical Policybcbsvermont2026-10-01
    Occupational Therapy Corporate Medical Policybcbsvermont2026-10-01
    Biomagnetic TherapyConnectiCare2026-09-11

    Related Codes

    HCPCS-L5000-PARTIAL-FOOT-SHOE-INSERT-LONGITUDINAL-ARCH-TOE-FILLER

    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

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    Frequently Asked Questions

    References

    1. 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. 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. 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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