HCPCS L-Codes
Orthotic and Prosthetic Procedures, Devices

Braces; trusses; and artifical legs, arms, and eyes are covered when furnished incident to a physician’s services or on a physician’s order. A brace includes rigid and semirigid devices used for the purpose of supporting a weak or deformed body member or restricting or eliminating motion in a diseased or injured part of the body. Back braces include, but are not limited to, sacroiliac, sacrolumbar, dorsolumbar corsets, and belts. Stump stockings and harnesses (including replacements) are also covered when these appliances are essential to the effective use of an artificial limb. Adjustments to an artificial limb or other appliance required by wear or by a change in the patient’s condition are covered when ordered by a physician. Adjustments, repairs, and replacements are covered so long as the device continues to be medically required.

• L6693

  Upper extremity addition, locking elbow, forearm counterbalance

• L6694

  Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism

• L6695

  Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism

• L6696

  Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695)

• L6697

  Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695)

• L6698

  Addition to upper extremity prosthesis, lock mechanism, excludes socket insert

• L6700

  Upper extremity addition, external powered feature, myoelectronic control module, additional emg inputs, pattern-recognition decoding intent movement

• L6703

  Terminal device, passive hand/mitt, any material, any size

• L6704

  Terminal device, sport/recreational/work attachment, any material, any size

• L6706

  Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined

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  Continued

• L6707

  Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined

• L6708

  Terminal device, hand, mechanical, voluntary opening, any material, any size

• L6709

  Terminal device, hand, mechanical, voluntary closing, any material, any size

• L6711

  Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined, pediatric

• L6712

  Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined, pediatric

• L6713

  Terminal device, hand, mechanical, voluntary opening, any material, any size, pediatric

• L6714

  Terminal device, hand, mechanical, voluntary closing, any material, any size, pediatric

• L6715

  Terminal device, multiple articulating digit, includes motor(s), initial issue or replacement

• L6721

  Terminal device, hook or hand, heavy duty, mechanical, voluntary opening, any material, any size, lined or unlined

• L6722

  Terminal device, hook or hand, heavy duty, mechanical, voluntary closing, any material, any size, lined or unlined

• L6805

  Addition to terminal device, modifier wrist unit

• L6810

  Addition to terminal device, precision pinch device

• L6880

  Electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s)

• L6881

  Automatic grasp feature, addition to upper limb electric prosthetic terminal device

• L6882

  Microprocessor control feature, addition to upper limb prosthetic terminal device

• L6883

  Replacement socket, below elbow/wrist disarticulation, molded to patient model, for use with or without external power

• L6884

  Replacement socket, above elbow/elbow disarticulation, molded to patient model, for use with or without external power

• L6885

  Replacement socket, shoulder disarticulation/interscapular thoracic, molded to patient model, for use with or without external power

• L6890

  Addition to upper extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment

• L6895

  Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated

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  Continued

• L6900

  Hand restoration (casts, shading and measurements included), partial hand, with glove, thumb or one finger remaining

• L6905

  Hand restoration (casts, shading and measurements included), partial hand, with glove, multiple fingers remaining

• L6910

  Hand restoration (casts, shading and measurements included), partial hand, with glove, no fingers remaining

• L6915

  Hand restoration (shading, and measurements included), replacement glove for above

• L6920

  Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal, switch, cables, two batteries and one charger, switch control of terminal device

• L6925

  Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device

• L6930

  Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device

• L6935

  Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device

• L6940

  Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device

• L6945

  Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device

• L6950

  Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device

• L6955

  Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device

• L6960

  Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device

• L6965

  Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device

• L6970

  Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device

• L6975

  Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device

• L7007

  Electric hand, switch or myoelectric controlled, adult

• L7008

  Electric hand, switch or myoelectric, controlled, pediatric

• L7009

  Electric hook, switch or myoelectric controlled, adult

• L7040

  Prehensile actuator, switch controlled