L5679 : HCPCS Code (2025) : XML

L5679 : Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, not for use with locking mechanism ( Socket insert w/o lock mech )

HCPCS Code : L5679 – XML Data Format

                
<?xml version="1.0" encoding="UTF-8"?>
<HCPCS>
	<HCPC>
		L5679
	</HCPC>
	<LongDescription>
		Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, not for use with locking mechanism
	</LongDescription>
	<ShortDescription>
		Socket insert w/o lock mech
	</ShortDescription>
	<PricingIndicators>
		<PricingIndicator>
			<PricingIndicatorName>
				38
			</PricingIndicatorName>
			<PricingIndicatorCode>
				Orthotics, prosthetics, prosthetic devices &amp; vision services (price subject to floors and ceilings) . Durable Medical Equipment, Prosthetics, Orthotics, Supplies And Surgical Dressings
			</PricingIndicatorCode>
		</PricingIndicator>
	</PricingIndicators>
	<MPI>
		A
	</MPI>
	<MultiplePricingIndicatorCode>
		Not applicable as HCPCS priced under one methodology
	</MultiplePricingIndicatorCode>
	<CIMs/>
	<MCMs>
	</MCMs>
	<Statute/>
	<LabCertifications/>
	<XReferences/>
	<Coverage>
		C
	</Coverage>
	<CoverageDescription>
		Carrier judgment
	</CoverageDescription>
	<ASCPayGrp/>
	<ASCPayGrpEffDate/>
	<MOGPayGrp/>
	<MOGPaymentGroupCode/>
	<MOGPayInd/>
	<MOGPaymentPolicyIndicator/>
	<MOGEffDate/>
	<ProcNote/>
	<BETOS>
		D1F
	</BETOS>
	<BETOSDescription>
		Prosthetic/Orthotic devices
	</BETOSDescription>
	<TypeOfServices>
		<TypeOfService>
			<TOS>
				P
			</TOS>
			<TypeOfServiceCode>
				Lump sum purchase of DME, prosthetics, orthotics
			</TypeOfServiceCode>
		</TypeOfService>
	</TypeOfServices>
	<AnestBaseUnits>
		0
	</AnestBaseUnits>
	<CodeAddDate>
		20040101
	</CodeAddDate>
	<ActionEffDate>
		20251001
	</ActionEffDate>
	<TermDate/>
	<ActionCode>
		C
	</ActionCode>
	<ActionCodeDescription>
		Change in long description of procedure or modifier code
	</ActionCodeDescription>
</HCPCS>

                
            

HCPCS XML XSD Schema

                
<xs:schema attributeFormDefault="unqualified" elementFormDefault="qualified" xmlns:xs="http://www.w3.org/2001/XMLSchema">
  <xs:element name="HCPCS">
    <xs:complexType>
      <xs:sequence>
        <xs:element type="xs:string" name="HCPC"/>
        <xs:element type="xs:string" name="LongDescription"/>
        <xs:element type="xs:string" name="ShortDescription"/>
        <xs:element name="PricingIndicators">
          <xs:complexType>
            <xs:sequence>
              <xs:element name="PricingIndicator" maxOccurs="unbounded" minOccurs="0">
                <xs:complexType>
                  <xs:sequence>
                    <xs:element type="xs:string" name="PricingIndicatorName"/>
                    <xs:element type="xs:string" name="PricingIndicatorCode"/>
                  </xs:sequence>
                </xs:complexType>
              </xs:element>
            </xs:sequence>
          </xs:complexType>
        </xs:element>
        <xs:element type="xs:string" name="MPI"/>
        <xs:element type="xs:string" name="MultiplePricingIndicatorCode"/>
        <xs:element name="CIMs">
          <xs:complexType>
            <xs:sequence>
              <xs:element type="xs:string" name="CIM" maxOccurs="unbounded" minOccurs="0"/>
            </xs:sequence>
          </xs:complexType>
        </xs:element>
        <xs:element name="MCMs">
          <xs:complexType>
            <xs:sequence>
              <xs:element type="xs:string" name="MCM" maxOccurs="unbounded" minOccurs="0"/>
            </xs:sequence>
          </xs:complexType>
        </xs:element>
        <xs:element type="xs:string" name="Statute"/>
        <xs:element name="LabCertifications">
          <xs:complexType>
            <xs:sequence>
              <xs:element name="LabCertification" maxOccurs="unbounded" minOccurs="0">
                <xs:complexType>
                  <xs:sequence>
                    <xs:element type="xs:string" name="LabCert"/>
                    <xs:element type="xs:string" name="LabCertificationCode"/>
                  </xs:sequence>
                </xs:complexType>
              </xs:element>
            </xs:sequence>
          </xs:complexType>
        </xs:element>
        <xs:element name="XReferences">
          <xs:complexType>
            <xs:sequence>
              <xs:element name="XReference" maxOccurs="unbounded" minOccurs="0">
                <xs:complexType>
                  <xs:sequence>
                    <xs:element type="xs:string" name="XRef"/>
                    <xs:element type="xs:string" name="XRefDescription"/>
                  </xs:sequence>
                </xs:complexType>
              </xs:element>
            </xs:sequence>
          </xs:complexType>
        </xs:element>
        <xs:element type="xs:string" name="Coverage"/>
        <xs:element type="xs:string" name="CoverageDescription"/>
        <xs:element type="xs:string" name="ASCPayGrp"/>
        <xs:element type="xs:string" name="ASCPayGrpEffDate"/>
        <xs:element type="xs:string" name="MOGPayGrp"/>
        <xs:element type="xs:string" name="MOGPaymentGroupCode"/>
        <xs:element type="xs:string" name="MOGPayInd"/>
        <xs:element type="xs:string" name="MOGPaymentPolicyIndicator"/>
        <xs:element type="xs:string" name="MOGEffDate"/>
        <xs:element type="xs:string" name="ProcNote"/>
        <xs:element type="xs:string" name="BETOS"/>
        <xs:element type="xs:string" name="BETOSDescription"/>
        <xs:element name="TypeOfServices">
          <xs:complexType>
            <xs:sequence>
              <xs:element name="TypeOfService" maxOccurs="unbounded" minOccurs="0">
                <xs:complexType>
                  <xs:sequence>
                    <xs:element type="xs:string" name="TOS"/>
                    <xs:element type="xs:string" name="TypeOfServiceCode"/>
                  </xs:sequence>
                </xs:complexType>
              </xs:element>
            </xs:sequence>
          </xs:complexType>
        </xs:element>
        <xs:element type="xs:string" name="AnestBaseUnits"/>
        <xs:element type="xs:float" name="CodeAddDate"/>
        <xs:element type="xs:float" name="ActionEffDate"/>
        <xs:element type="xs:string" name="TermDate"/>
        <xs:element type="xs:string" name="ActionCode"/>
        <xs:element type="xs:string" name="ActionCodeDescription"/>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
</xs:schema>