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    v1.0.28
    OpenPayerBilling CodesProsthetic ProceduresHCPCS hcpcs-l8417-prosthetic-sheath-sock-gel-cushion-below-or-above-knee
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    HCPCS L8417: Prosthetic Sheath/Sock with Gel Cushion, Below or Above Knee

    HCPCS Level II code L8417 describes a prosthetic sheath/sock with an integrated gel cushion layer for below-knee or above-knee prostheses, intended as a durable external accessory to improve socket comfort and pressure distribution; service type is prosthetic supply and fitting, and the typical site of service is outpatient prosthetics clinics or durable medical equipment providers supplying limb prosthesis accessories.

    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 patient with a transtibial or transfemoral amputation presents to a prosthetics clinic for fitting and delivery of a prosthetic sheath/sock that includes an integrated gel cushion layer. Typical patients are adults or adolescents recovering from limb loss due to trauma, peripheral arterial disease, diabetes-related complications, or tumor resection. The clinical workflow begins with a prosthetist or orthotist evaluation documenting limb volume, skin integrity, and suspension needs; measurement and selection of an appropriate sheath/sock size and thickness; fitting with the prosthetic socket and liner; patient education on donning/doffing, wear schedule, skin checks, and replacement intervals; and documentation for billing.

    A typical scenario: a 62-year-old patient with a healed transtibial amputation secondary to diabetic foot infection attends a prosthetics follow-up. The prosthetist assesses residual limb volume fluctuation and prescribes a below-knee prosthetic sheath with an integrated gel cushion layer to improve comfort and pressure distribution under the socket. The sheath/sock is measured, fabricated or selected from stock, applied during a fitting session, and replaced or adjusted as needed during subsequent visits. Documentation includes the device description L8417, laterality RT or LT when applicable, diagnosis code(s) supporting medical necessity, and any applicable modifiers for billing.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    97760Orthotic management and training, upper or lower extremity, initial encounter; subsequent encounters reported with 97761Used for patient training in donning/doffing and use of the prosthesis with the new sheath/sock
    97530Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance)May be used during prosthetic rehabilitation sessions following sheath/sock fitting
    97110Therapeutic exercises to develop strength, endurance, range of motion and flexibilityUsed in physical therapy visits addressing residual limb conditioning associated with prosthetic use
    99456Work-related or medical disability examination services (when applicable)May be used for functional capacity evaluations related to return-to-work after amputation and prosthetic fitting
    99070Supplies and materials (except spectacles), provided by the clinic over and above those usually included with the office visitMay be billed when clinic supplies specific to the sheath/sock fitting are provided

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    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…
    59Modifier 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…
    2PModifier -2P is a Category II performance‑measure exclusion appended to a CPT Category II (quality) code when the provider did not perform the measured action because of patient‑related reasons (for…- Use modifier 2P only with CPT Category II (performance‑measure) codes when a patient‑specific reason prevented performance of the measured action (for example, patient refusal, economic or social…
    95Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…
    99Modifier 99 is a placeholder modifier used when more modifiers apply to a single procedure than the claim form or electronic field allows. The AMA classifies it under Provider Services and Ambulatory…- Use CPT modifier -99 when more modifiers apply to a single procedure line than the claim form or payer field allows (CMS/Noridian: when more than four modifiers are needed); append modifier 99 on…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207K00000XAllergy & Immunology PhysicianAn allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
    2084P0800XPsychiatry PhysicianA Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
    3416S0300XWater AmbulanceTransportation Services · Ambulance
    164W00000XLicensed Practical NurseAn individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required f…
    133VN1201XObesity and Weight Management Nutrition Registered DietitianAn individual who is a Board Certified Specialist for Obesity and Weight Management and educates, supports, and advocates for patients and clients to …
    2278P3800XPalliative/Hospice Certified Respiratory TherapistA coordinated plan of care to help dying patients and their families handle the burden of terminal care. Effective secretion management and relief of…
    207VF0040XUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianA subspecialist in Urogynecology and Reconstructive Pelvic Surgery is a physician in Urology or Obstetrics and Gynecology who, by virtue of education …
    315P00000XIntellectual Disabilities Intermediate Care FacilityAn intermediate care facility providing services for individuals with intellectual disabilities.

    Related ICD-10-CM Codes

    26 rows

    ICD-10-CM CodeDescription
    E11.52Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene
    I73.9Peripheral vascular disease, unspecified
    L97.409Non-pressure chronic ulcer of unspecified heel and midfoot with unspecified severity
    L97.509Non-pressure chronic ulcer of other part of unspecified foot with unspecified severity
    L97.909Non-pressure chronic ulcer of unspecified part of unspecified lower leg with unspecified severity
    M21.611Bunion of right foot
    M21.612Bunion of left foot
    M21.619Bunion of unspecified foot
    M24.271Disorder of ligament, right ankle
    M24.272Disorder of ligament, left ankle

    Showing 1–10 of 26

    Related Payer Policy Updates

    Specialty: Physical Medicine, Rehab & Therapies1 / 2

    3 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

    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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