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 PIN on all applications and invoices. Details about reimbursements for definitive sockets are in Prosthetic and Orthotic Policy Manual, Section 5.2.4
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| 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 |
| 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 |