A 9 minute read
25-most-common-prosthetics
July 16, 2019

The Amputee Coalition of America estimates that, as of 2017, two million people are living with limb loss in the U.S. This is a high number for such a seemingly uncommon procedure, but in reality it is much more common than expected, with doctors performing about 200,000 amputations each year. And, naturally, each amputation necessitates a prosthetic limb.

prosthesis (also called a prosthetic limb or artificial limb) is a substitute for a limb lost through a congenital defect, accident, traumatic injury, or illness. Among the illnesses, the main causes of limb loss are vascular disease – diabetes and peripheral arterial disease.

Curious about which prostheses are most popular among physicians? Here are the top 25 most common prostheses by total number of claims:

25 Most Common Prosthetics by Total # of Claims

Rank CPT Code Description of Prosthetic Total # of Claims Total # of Services
1.  L8000 Mastectomy bra 55,913 154,070
2.  L8030 Breast prosthesis, silicone or equal 9,832 11,835
3.  L8420 Prosthetic sock, multiple ply, below knee 4,840 35,108
4.  L5637 Addition to lower extremity, below knee, total contact 4,237 4,484
5.  L5620 Addition to lower extremity, test socket, below knee 4,103 6,000
6.  L5671 Below knee/above knee suspension locking mechanism 3,427 3,647
7.  L5910 Addition, endoskeletal system, below knee, alignable system 3,029 3,209
8.  L5629 Addition to lower extremity, below knee, acrylic socket 3,004 3,194
9.  L5940 Addition, endoskeletal system, below knee, ultra-light material  2,686 2,855
10.  L5685 Addition to below knee prosthesis, suspension/sealing sleeve 2,407 4,419
11.  L5679 Addition to below knee prosthesis, custom fabrication  2,402 4,568
12.  L8020 Breast prosthesis, mastectomy form 1,667 2,074
13.  L8015 External breast prosthesis garment, post mastectomy 1,581 2,558
14.  L5645 Addition to below knee extremity, flex. inner socket, ext. frame 1,300 1,391
15.  L8440 Prosthetic shrinker, below knee 1,288 2,710
16.  L5986 All lower extremity prostheses, multi-axial rotation unit 1,197 1,265
17.  L5301 Below knee, molded socket, endoskeletal system 1,162 1,230
18.  L8400 Partial foot, shoe insert with longitudinal arch, toe filler 1,060 6,621
19.  L8501 Tracheostomy speaking valve 1,002 1,042
20.  L5704 Custom shaped protective cover, below knee 837 893
21.  L5624 Addition to lower extremity, test socket, above knee 836 1,279
22.  L5700 Replacement, socket, below knee, molded to patient model 799 853
23. L5650 Additions to lower extremity, knee disarticulation socket 793 814
24.  L5649 Addition to lower extremity, ischial containment/narrow socket 775 795
25.  L5651 Addition to above knee extremity, flex. inner socket, ext. frame 696 714

Fig 1 Medical equipment by HCPCS/CPT code (2016 Medicare data), from Definitive Healthcare's Physicians Market Analytics database.

It's evident that the most common prosthetics fall into two categories:

1. Breast Prostheses

The number of women choosing to have mastectomies over breast-sparing procedures has been rising significantly in the U.S. — many citing a desire to avoid excess radiation treatments, biopsies, and mammograms.

Following the mastectomy procedure, some women choose to have breast reconstruction, but if a patient decides that breast reconstruction isn’t right for them, but still wants a breast shape, a prosthesis or breast form can help them look balanced without surgery. There are a wide variety of breast prostheses that typically serve as a replacement after a mastectomy, and many are featured in the list above.

2. Leg Prostheses

Amputation rates have been rising significantly in people under 65 with diabetes since 2009, according to the U.S. Centers for Disease Control and Prevention — a trend that is particularly strong for (1) so-called minor amputations of toes and feet (rising 62 percent from 2009 to 2015) and (2) major amputations, those done above or just below the knee — up by 29 percent. 

Given this uptick, it's no wonder that "below the knee" prosthetic leg parts and sockets saw some of the highest number of claims in 2016. Below the knee, or transtibial, prosthetics are typically attached to an intact upper leg, just below the knee. They are fit with a socket, which is carefully molded around a plaster cast taken from the residual limb.

In these codes, it's apparent that sockets make up a large portion of the prosthetics market. This may be because a patient's residual limb is likely to change shape and size over time, so new sockets will be needed as the patient ages. But, with modern technology, more precisely-fitting sockets are now in the works, as developers have the ability to scan a patient's residual limb with lasers and use 3-D printing to create an exact fit.

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Want to assess demand for your medical device products within a specific hospital, IDN, or other health network? Definitive Healthcare's Provider database can help you identify burgeoning demand for prosthetics or medical equipment, based on U.S. claims data.

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