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 vascular diseases, such as diabetes.
By the end of 2021, more than 262,000 claims for limb amputation were submitted, according to Definitive Healthcare data from ClaimsMx.
Below, we've compiled a list of the most common prosthetics by total claims volume.
25 Most common prosthetics by claims volume, 2021
| Rank | HCPCS/CPT Code | HCPCS/CPT Description | # Total Procedures | Total Charges | Avg Charge/Procedure | Explore Dataset |
|---|---|---|---|---|---|---|
| 1 | L8699 | Prosthetic implant, not otherwise specified | 191,178 | $643,896,514 | $3,368 | Explore |
| 2 | L8000 | Mastectomy bra | 8,495 | $1,694,849 | $200 | Explore |
| 3 | L8680 | Implantable neurostimulator electrode each | 8,131 | $130,117,549 | $16,003 | Explore |
| 4 | L8612 | Aqueous shunt prosthesis | 6,292 | $17,530,621 | $2,786 | Explore |
| 5 | L8600 | Implant breast silicone/eq | 6,034 | $33,243,667 | $5,509 | Explore |
| 6 | L8610 | Ocular implant | 4,741 | $4,740,133 | $1,000 | Explore |
| 7 | L8606 | Synthetic implant urinary 1ml | 3,490 | $9,092,328 | $2,605 | Explore |
| 8 | L8613 | Ossicular implant | 3,352 | $3,327,822 | $993 | Explore |
| 9 | L8420 | Prosthetic sock multiple ply below knee | 3,229 | $561,798 | $174 | Explore |
| 10 | L8030 | Breast prostheses w/o adhesive | 2,957 | $1,783,803 | $603 | Explore |
| 11 | L8614 | Cochlear device | 2,677 | $208,664,499 | $77,947 | Explore |
| 12 | L8470 | Prosthetic sock single ply below knee | 2,334 | $135,774 | $58 | Explore |
| 13 | L8509 | Tracheo-esophageal voice prosthesis | 2,188 | $2,367,909 | $1,082 | Explore |
| 14 | L8687 | Implantable neurostimulator pulse generator, dual array, rechargeable | 1,841 | $76,764,921 | $41,697 | Explore |
| 15 | L8440 | Shrinker below knee | 1,747 | $213,840 | $122 | Explore |
| 16 | L8689 | External recharging system for battery (internal) | 935 | $5,772,740 | $6,174 | Explore |
| 17 | L8690 | Auditory osseointegrated device, includes all internal and external components | 934 | $19,042,011 | $20,388 | Explore |
| 18 | L8400 | Sheath below knee | 885 | $123,966 | $140 | Explore |
| 19 | L8015 | External breast prosthesis garment | 810 | $155,136 | $192 | Explore |
| 20 | L8681 | Patient programmer for use with implantable programmable neurostimulator | 770 | $2,104,132 | $2,733 | Explore |
| 21 | L8679 | Implantable Neurostimulator, Pulse Generator, Any Type | 752 | $26,051,531 | $34,643 | Explore |
| 22 | L8430 | Prosthetic sock, multiple ply, above knee | 675 | $145,207 | $215 | Explore |
| 23 | L8641 | Metatarsal joint implant | 633 | $2,997,798 | $4,736 | Explore |
| 24 | L8688 | Implantable neurostimulator pulse generator, dual array, non-rechargeable | 605 | $24,725,259 | $40,868 | Explore |
| 25 | L8686 | Implantable neurostimulator pulse generator, single array, non-rechargeable | 563 | $24,070,099 | $42,753 | Explore |
Fig 1. Data is from Definitive Healthcare’s Medical Claims database. Claims volumes are from the calendar year 2021 and are sourced from multiple clearinghouses. Procedure volumes were gathered from individual physicians across facility types. Accessed Jan. 2022.
The top two most common prosthetic categories
It's evident that the most common prosthetics fall into two categories:
Breast Prostheses
Of the top 25 most common prosthetics in 2021, more than 18,000 breast implant and similar procedures were performed. This includes external breast prosthesis garment (L8015), breast prostheses w/o adhesive (L8030) and more.
The number of women choosing to have mastectomies is holding steady in the United States. Using claims data, Definitive Healthcare tracked over 50,000 mastectomies in 2021. There were 51,000 procedures in 2020 and 53,000 in 2019.
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 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 realistic option. Silicone prostheses (L8600) were another common procedure in 2021, totaling 6,034 procedures.
Leg Prostheses
Below-the-knee prosthetic parts and sockets saw some of the highest claim volumes. This includes accessories like prosthetic socks (L8420 and L8470) with 3,229 and 2,334 procedures performed in 2021 respectively.
Below-the-knee, or transtibial, prosthetics attach to the upper leg, just below the knee. They are fit with a socket, 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. This includes HCPCS L8430, which is a prosthetic sock above knee prosthetic with 675 procedures performed in 2021. 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. Some of which include:
- 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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