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    v1.0.28
    OpenPayerBilling CodesProsthetic ProceduresHCPCS hcpcs-l8430-prosthetic-sock-multiple-ply-above-knee
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    HCPCS L8430: Prosthetic Sock, Multiple Ply, Above Knee

    HCPCS Level II code L8430 describes a multiple-ply prosthetic sock for above-knee amputees, intended as a removable interface component used with an above-knee prosthesis to improve socket fit and comfort; service type: prosthetic supply; typical site of service: outpatient prosthetics clinic or durable medical equipment provider setting.

    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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    Clinical & Coding Specifications

    Clinical Context

    A patient with an above-knee amputation presents to a prosthetics clinic for supply of soft interface materials to optimize socket fit and skin protection. The patient typically is a new or established prosthesis user who reports residual limb volume fluctuation, pressure points, or skin irritation from the prosthetic socket. A certified prosthetist evaluates the limb, documents limb measurements, skin condition, and the need for a multiple-ply above-knee prosthetic sock to manage volume and improve comfort. The clinic dispenses L8430 (prosthetic sock, multiple ply, above knee, each) as part of routine socket fitting, doffing/doffing education, and follow-up. Typical workflow: prosthetist assessment and documentation -> selection of sock ply and quantity -> patient education on sock use and hygiene -> issuance of item and documentation of date of delivery and item description in the medical record. Typical site of service is an outpatient prosthetics/orthotics clinic, rehabilitation facility, or durable medical equipment (DME) supplier location.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    97760Orthotic management and training, initial encounter, lower extremity with training of prosthetic usePerformed during prosthetic fitting visits when training the patient in sock use and donning/doffing
    97763Orthotic/prosthetic training, subsequent encounterUsed for follow-up visits for ongoing sock/fit adjustment and training
    99456Work-related and medical disability examinations and evaluations (impairment rating)May be used when formal functional evaluation or impairment documentation is required in the prosthetic care plan
    99070Supplies and materials provided by the physician over and above those usually included with the office visitOccasionally used by clinics when billing for supplies associated with prosthetic care beyond standard visit services
    99213Office or other outpatient visit for the evaluation and management of an established patientTypical E/M visit code used when clinical assessment and documentation accompany dispensing of L8430

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    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…
    56Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…
    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…
    1PModifier 1P is a Category II performance measure exclusion modifier used to indicate that a patient’s medical condition prevented performance of the action specified by a Category II quality measure…- Use modifier 1P only with Category II (quality reporting) codes when the specific measure’s reporting instructions explicitly allow a medical-reason exclusion; it marks the patient as medically…
    58Modifier 58 (Staged or related procedure/service by the same physician during the postoperative period) indicates that a subsequent procedure performed by the same provider during the…- Use modifier 58 when the same physician/QHP performs a procedure during the postoperative/global period of an earlier procedure and the subsequent procedure is either planned or anticipated…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    208D00000XGeneral Practice PhysicianA physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    2083C0008XClinical Informatics PhysicianPhysicians who practice Clinical Informatics collaborate with other health care and information technology professionals to analyze, design, implement…
    152W00000XOptometristDoctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injurie…
    226000000XRecreational Therapist AssistantRecreational Therapist Assistants work in support of or assistant to Recreational Therapists treating patients with disabilities, injuries, and illnes…
    174H00000XHealth EducatorHealth educators work in a variety of settings providing education to individuals or groups of individuals on healthy behaviors, wellness, and health-…
    385H00000XRespite CareRespite Care Facility · Respite Care
    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…

    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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