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    v1.0.28
    OpenPayerBilling CodesProsthetic ProceduresHCPCS hcpcs-l5962-below-knee-endoskeletal-flexible-covering
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    HCPCS L5962: Below-Knee Endoskeletal Flexible Protective Covering

    HCPCS Level II code L5962 describes the addition of an endoskeletal system component for a below-knee prosthesis that provides a flexible protective outer surface covering; this is a prosthetic component service used in prosthetics and orthotics care, typically provided in an outpatient prosthetics clinic or specialty durable medical equipment facility for patients receiving below-knee prosthetic fittings and modifications.

    For related coverage guidance, see recent payer policy updates: Clinical Review Criteria — Lymphedema Therapy and Training (Complete Decongestive Therapy; LVA), Therapy Services — Electric Stimulation for Pain, Swelling and Function in a Clinic Setting, Site of Care: Outpatient Hospital Setting for Physical and Occupational Therapy.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 62-year-old patient with a transtibial (below-knee) amputation presents to a prosthetics clinic for fitting and customization of an endoskeletal prosthesis. The prosthetist evaluates the residual limb, ambulatory goals, and activity level. The clinician determines the patient will receive an endoskeletal pylon system with a flexible protective outer covering to provide impact resistance and cosmesis. The workflow includes a clinical assessment, casting or digital scan of the residual limb, selection and fabrication of the endoskeletal pylon and socket interface, addition of the flexible protective outer surface covering (L5962), fitting and alignment session, and follow-up adjustments. Typical site of service is an outpatient prosthetics and orthotics clinic or a specialized rehabilitation prosthetics center. Typical patient scenario: a below-knee amputee requiring a protective outer covering for an endoskeletal prosthesis to protect components from moisture, debris, and incidental impact while improving durability and appearance.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    97760Orthotic management and training; initial encounter for prosthetic training, gait training (lower extremity)Used during initial training after prosthetic fitting and addition of the protective covering
    97761Prosthetic training, subsequent encountersUsed for follow-up training sessions after initial prosthetic fitting
    99070Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or other servicesMay be used to report nonstandard supplies related to prosthetic covering when payor allows
    97530Therapeutic activities, direct (one-on-one) patient contactUsed for functional mobility and ADL training associated with new prosthesis fitting
    20610Arthrocentesis, aspiration and/or injection; major joint or bursa (if clinically needed)Rarely related but may be used if joint injections are provided during peri-prosthetic care

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    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…
    54Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    208D00000XGeneral Practice PhysicianA physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
    2084P0800XPsychiatry PhysicianA Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
    2080H0002XPediatric Hospice and Palliative Medicine PhysicianA pediatrician with special knowledge and skills to prevent and relieve the suffering experienced by patients with life-limiting illnesses. This speci…
    207RS0010XSports Medicine (Internal Medicine) PhysicianAn internist trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but al…
    207XS0114XAdult Reconstructive Orthopaedic Surgery PhysicianRecognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, adult reconstructive orthopaedic surgeons deal…
    2279P1005XPulmonary Rehabilitation Registered Respiratory TherapistThe respiratory therapist can assist the chronic pulmonary patient in returning to an optimal role in society by providing an effective program. It i…
    227900000XRegistered Respiratory TherapistA Registered Respiratory Therapist (RRT) is an advanced therapist who has passed standardized written and clinical simulation examinations administere…

    Related Payer Policy Updates

    Specialty: Physical Medicine, Rehab & Therapies1 / 2

    10 rows

    PolicyPayerEffective Date
    Clinical Review Criteria — Lymphedema Therapy and Training (Complete Decongestive Therapy; LVA)Kaiser Permanente2026-09-01
    Therapy Services — Electric Stimulation for Pain, Swelling and Function in a Clinic SettingCigna2026-08-15
    Site of Care: Outpatient Hospital Setting for Physical and Occupational TherapyCigna2026-08-15
    Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech)Colorado Rocky Mountain Health Plans2026-08-01
    Cognitive Rehabilitation and Coma Stimulation (for Tennessee Only)UnitedHealthcare2026-08-01
    Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for Kentucky Only)UnitedHealthcare2026-08-01
    Home Traction Therapy (for Pennsylvania Only)UnitedHealthcare2026-08-01
    Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for Florida Only)Colorado Rocky Mountain Health Plans2026-08-01
    Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for Pennsylvania Only)UnitedHealthcare2026-08-01
    Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for North Carolina Only)UnitedHealthcare2026-08-01

    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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