Table of content for "Add low ext man aut vol any" (HCPCS L5657)
General information on the “L5657” code
HCPCS Code: L5657
Long Description: Addition to lower extremity prosthesis, manual/automated adjustable air, fluid, gel or equal socket insert for limb volume management, any materials
Short Description: Add low ext man aut vol any
Original information is taken from L5657 page
Pricing indicators
Pricing Indicator Code 1: 46 – Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap-filled amounts). Durable Medical Equipment, Prosthetics, Orthotics, Supplies And Surgical Dressings
Multiple Pricing Indicator Code A : Not applicable as HCPCS priced under one methodology
Certification and additional reference information
Coverage
Coverage: C – Carrier judgment
Type of service
Berenson-Eggers Type of Service (BETOS): D1F – Prosthetic/Orthotic devices
Type Of Service 1: P – Lump sum purchase of DME, prosthetics, orthotics
Misc information
Anesthesia Base Unit Quantity: 0
Code Added Date: 20251001
Code Effective Date: 20251001
Action Code: A – Add procedure or modifier code