Healthcare Insights
Top 25 most common prosthetics by claims volume
More than 2.1 million people in the U.S. were living with limb loss in 2021. This number is expected to double by 2050, indicating new opportunities for prosthetic developers and specialists to help improve health outcomes for people living with an amputated limb. For many, a prosthetic limb offers improved mobility and a means to stay independent and active in one’s community.
What is limb loss?
Limb loss, or amputation, may occur through a congenital defect, accident, traumatic injury, or illness. The main illness-related causes of limb loss are peripheral vascular disease (often associated with diabetes) and trauma.
In 2022, below-the-knee amputations were the most common amputation procedures, representing 33.6% of related claims, according to Definitive Healthcare data from the Atlas All-Payor Claims Dataset.
Many people living with the loss of a body part choose to wear prosthetics to support functionality in daily life or for aesthetic purposes. However, many other prosthetics are designed to support people recovering from injury or living without the loss of a body part. Below, we’ve compiled a list of the most common prosthetics by total claims volume.
| Rank | HCPCS/CPT Code | HCPCS/CPT Description | % of total prosthetics procedures in U.S. for 2022 | Explore dataset |
|---|---|---|---|---|
| 1 | L8699 | Prosthetic implant NOS | 57.02% | Explore |
| 2 | L8000 | Mastectomy bra | 3.85% | Explore |
| 3 | L8606 | Synthetic implnt urinary 1ml | 2.73% | Explore |
| 4 | L8600 | Implant breast silicone/eq | 2.63% | Explore |
| 5 | L8680 | Implt neurostim elctr each | 2.43% | Explore |
| 6 | L8613 | Ossicular implant | 2.22% | Explore |
| 7 | L8610 | Ocular implant | 1.83% | Explore |
| 8 | L8612 | Aqueous shunt prosthesis | 1.67% | Explore |
| 9 | L8509 | Trach-esoph voice pros md in | 1.31% | Explore |
| 10 | L8614 | Cochlear device | 1.29% | Explore |
| 11 | L8030 | Breast prosthes w/o adhesive | 1.20% | Explore |
| 12 | L8420 | Prosthetic sock multi ply BK | 0.98% | Explore |
| 13 | L5673 | Socket insert w lock mech | 0.85% | Explore |
| 14 | L5000 | Sho insert w arch toe filler | 0.76% | Explore |
| 15 | L8470 | Pros sock single ply BK | 0.71% | Explore |
| 16 | L5637 | Below knee total contact | 0.70% | Explore |
| 17 | L5620 | Test socket below knee | 0.70% | Explore |
| 18 | L5629 | Below knee acrylic socket | 0.65% | Explore |
| 19 | L5940 | Endo bk ultra-light material | 0.61% | Explore |
| 20 | L5671 | BK/AK locking mechanism | 0.61% | Explore |
| 21 | L8687 | Implt nrostm pls gen dua rec | 0.58% | Explore |
| 22 | L5910 | Endo below knee alignable sy | 0.56% | Explore |
| 23 | L9900 | O&P supply/accessory/service | 0.53% | Explore |
| 24 | L8440 | Shrinker below knee | 0.52% | Explore |
| 25 | L5685 | Below knee sus/seal sleeve | 0.50% | Explore |
Fig. 1 Data is from Definitive Healthcare’s Atlas All-Payor Claims database. Claims volumes are from the calendar year 2022 and represent procedures in the L5000-L9900 HCPCS range sourced from multiple clearinghouses. Procedure volumes were gathered from individual physicians across facility types. Accessed May 2023.
The top two most common prosthetic categories
Based on our data, it’s evident that the most common prosthetics fall into two categories:
Breast prostheses
Of all prosthetic procedures performed in 2022, around 7.68% were for breast implants and similar procedures were performed. This includes silicone breast implants (L8600), breast prostheses w/o adhesive (L8030), and more. When excluding the massive volume of unspecified prosthetic implants (L8699), this figure rises to nearly 18% of total procedures.
The number of women choosing to have mastectomies is holding steady in the United States.
Many women who choose mastectomies hope to avoid radiation treatments, biopsies, and mammograms. Following a mastectomy, some women choose breast reconstruction.
If a patient decides that breast reconstruction isn’t for them, a prosthesis or breast form can help them look and/or feel balanced without surgery. Breast prostheses come in a variety of shapes, sizes, and materials. Common prosthetic fillings include silicone gel, foam, and fiberfill. Foam and fiberfill are lightweight options, while silicone is a more lifelike option.
Silicone prostheses (L8600) were another common procedure in 2022, representing 2.63% of all prosthetic procedures (or 6.13% when excluding unspecified prosthetics).
Leg prostheses
Below-the-knee prosthetic parts and sockets saw some of the highest claim volumes, with 8.15% of all prosthetic procedures, or 18.96% without unspecific prosthetics. This includes accessories like prosthetic socks (L8420 and L8470) with 2.29% and 1.65% of procedures (excluding unspecific prosthetics) performed in 2022 respectively.
Below-the-knee, or transtibial, prosthetics attach to the upper leg, just below the knee. They are fitted with a socket (such as procedure L5673) which is carefully molded around a plaster cast taken from the residual limb.
Above knee, or transfemoral, prosthetics are for patients who have had all or part of their upper legs amputated. Above-the-knee prosthetics can be more difficult to use than below-the-knee prosthetics. An intact knee joint makes movement easier for a patient, meaning less time is needed to adjust to a prosthetic.
Whether a leg prosthesis is “right” for a patient depends on several factors, including:
- The amount of soft tissue covering the femur
- If the patient feels significant pain in this area
- The condition of the skin on the residual limb
- Range of motion for the residual limb
- Patient activity level before the amputation
Who uses prosthetic data?
There are many reasons to leverage data on amputations and prosthetics. Medical device companies can use this information to assess the competitive market and identify displacement opportunities. They can also identify where competing devices are being used and avoid those regions—or develop specialized value propositions.
Healthcare staffing firms can also use prosthetics data. If a firm needs to place a surgeon, they can find the facilities performing the highest amputation volumes. Additionally, if a candidate has experience with specific prosthetic types, a firm can analyze outcomes at facilities using those devices. Then they can identify facilities that would most benefit from a surgical specialist.
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