Reimbursement schedule for definitive sockets
Last updated on January 31, 2024To print this page, press CTRL+P
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 5.2.4.
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
| 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 |