Reimbursement Schedule for Definitive Sockets

The PharmaCare maximum reimbursements for prosthetic procedures involved in providing a laminated definitive socket listed below are based on the type/level of socket being fitted.

Use the applicable Product Identification Number (PIN) on all applications and invoices. For additional information about reimbursements for definitive sockets refer to the Prosthetic and Orthotic Program Policy Manual, Section 5.2.3. To print this page, press CTRL+P.

Lower body

Definitive sockets of the lower body
PIN (Left) PIN (Right) Abbreviation Level of Amputation Maximum Reimbursement
77123207 77123190 TM Transmetatarsal By approval
77123402 77123396 TC Transtarsal (includes Lisfranc/tarsometatarsal and Chopart/midtarsal) $2,760
77123384 77123372 SY Symes $3,365
77123360 77123347 TT Transtibial $3,420
77123526 77123527 RP Rotationplasty (includes Van Nes)  $3,530
77123487 77123475 KD Knee disarticulation $4,565
77123359 77123335 TF Transfemoral $4,300
77123546 77123547 TF-Osseo Transfemoral osseointegration By approval
77123559 77123558 TT-Osseo Transtibial osseointegration By approval
77123524 77123525 PD Proximal femoral focal deficiency $4,635
77123440 77123438 HD Hip disarticulation $4,820
77123522 77123523 HP Hemipelvectomy $4,950

Upper body

Definitive sockets of the upper body
PIN (Left) PIN (Right) Abbreviation Level of Amputation Maximum Reimbursement
77123518 77123519 WD Wrist disarticulation $2,925
77123281 77123268 TR Transradial $2,650
77123520 77123521 ED Elbow disarticulation $3,860
77123270 77123256 TH Transhumeral $3,090
77123463 77123451 SD Shoulder disarticulation $3,940