Coding: Browse HCPCS Level II 2020 Edition

Browse HCPCS Level II 2020 Edition

HCPCS Level II Table of Contents

L6600 - L6698 Prosthetic Procedures - Additions to Upper Limb

L6600

Upper extremity additions, polycentric hinge, pair

short

Polycentric hinge pair

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6605

Upper extremity additions, single pivot hinge, pair

short

Single pivot hinge pair

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6610

Upper extremity additions, flexible metal hinge, pair

short

Flexible metal hinge pair

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6611

Addition to upper extremity prosthesis, external powered, additional switch, any type

short

Additional switch, ext power

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	3 Date of Service Edit: Clinical	Anatomic Consideration
DME	2.0	3 Date of Service Edit: Clinical	Anatomic Consideration

L6615

Upper extremity addition, disconnect locking wrist unit

short

Disconnect locking wrist uni

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6616

Upper extremity addition, additional disconnect insert for locking wrist unit, each

short

Disconnect insert locking wr

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6620

Upper extremity addition, flexion/extension wrist unit, with or without friction

short

Flexion/extension wrist unit

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6621

Upper extremity prosthesis addition, flexion/extension wrist with or without friction, for use with external powered terminal device

short

Flex/ext wrist w/wo friction

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6623

Upper extremity addition, spring assisted rotational wrist unit with latch release

short

Spring-ass rot wrst w/ latch

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6624

Upper extremity addition, flexion/extension and rotation wrist unit

short

Flex/ext/rotation wrist unit

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6625

Upper extremity addition, rotation wrist unit with cable lock

short

Rotation wrst w/ cable lock

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6628

Upper extremity addition, quick disconnect hook adapter, otto bock or equal

short

Quick disconn hook adapter o

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6629

Upper extremity addition, quick disconnect lamination collar with coupling piece, otto bock or equal

short

Lamination collar w/ couplin

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6630

Upper extremity addition, stainless steel, any wrist

short

Stainless steel any wrist

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6632

Upper extremity addition, latex suspension sleeve, each

short

Latex suspension sleeve each

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	4.0	3 Date of Service Edit: Clinical	Clinical: CMS Workgroup
DME	4.0	3 Date of Service Edit: Clinical	Clinical: Data

L6635

Upper extremity addition, lift assist for elbow

short

Lift assist for elbow

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6637

Upper extremity addition, nudge control elbow lock

short

Nudge control elbow lock

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6638

Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow

short

Elec lock on manual pw elbow

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6640

Upper extremity additions, shoulder abduction joint, pair

short

Shoulder abduction joint pai

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6641

Upper extremity addition, excursion amplifier, pulley type

short

Excursion amplifier pulley t

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	3 Date of Service Edit: Clinical	Anatomic Consideration
DME	2.0	3 Date of Service Edit: Clinical	Anatomic Consideration

L6642

Upper extremity addition, excursion amplifier, lever type

short

Excursion amplifier lever ty

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	3 Date of Service Edit: Clinical	Anatomic Consideration
DME	2.0	3 Date of Service Edit: Clinical	Anatomic Consideration

L6645

Upper extremity addition, shoulder flexion-abduction joint, each

short

Shoulder flexion-abduction j

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6646

Upper extremity addition, shoulder joint, multipositional locking, flexion, adjustable abduction friction control, for use with body powered or external powered system

short

Multipo locking shoulder jnt

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6647

Upper extremity addition, shoulder lock mechanism, body powered actuator

short

Shoulder lock actuator

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6648

Upper extremity addition, shoulder lock mechanism, external powered actuator

short

Ext pwrd shlder lock/unlock

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6650

Upper extremity addition, shoulder universal joint, each

short

Shoulder universal joint

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6655

Upper extremity addition, standard control cable, extra

short

Standard control cable extra

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	4.0	3 Date of Service Edit: Clinical	Clinical: CMS Workgroup
DME	4.0	3 Date of Service Edit: Clinical	Clinical: Data

L6660

Upper extremity addition, heavy duty control cable

short

Heavy duty control cable

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	4.0	3 Date of Service Edit: Clinical	Clinical: CMS Workgroup
DME	4.0	3 Date of Service Edit: Clinical	Clinical: Data

L6665

Upper extremity addition, teflon, or equal, cable lining

short

Teflon or equal cable lining

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	4.0	3 Date of Service Edit: Clinical	Clinical: CMS Workgroup
DME	4.0	3 Date of Service Edit: Clinical	Clinical: Data

L6670

Upper extremity addition, hook to hand, cable adapter

short

Hook to hand cable adapter

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6672

Upper extremity addition, harness, chest or shoulder, saddle type

short

Harness chest/shlder saddle

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6675

Upper extremity addition, harness, (e.g., figure of eight type), single cable design

short

Harness figure of 8 sing con

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6676

Upper extremity addition, harness, (e.g., figure of eight type), dual cable design

short

Harness figure of 8 dual con

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6677

Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow

short

Ue triple control harness

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6680

Upper extremity addition, test socket, wrist disarticulation or below elbow

short

Test sock wrist disart/bel e

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	4.0	3 Date of Service Edit: Clinical	Nature of Equipment
DME	4.0	3 Date of Service Edit: Clinical	Nature of Equipment

L6682

Upper extremity addition, test socket, elbow disarticulation or above elbow

short

Test sock elbw disart/above

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	4.0	3 Date of Service Edit: Clinical	Nature of Equipment
DME	4.0	3 Date of Service Edit: Clinical	Nature of Equipment

L6684

Upper extremity addition, test socket, shoulder disarticulation or interscapular thoracic

short

Test socket shldr disart/tho

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	4.0	3 Date of Service Edit: Clinical	Nature of Equipment
DME	4.0	3 Date of Service Edit: Clinical	Nature of Equipment

L6686

Upper extremity addition, suction socket

short

Suction socket

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6687

Upper extremity addition, frame type socket, below elbow or wrist disarticulation

short

Frame typ socket bel elbow/w

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6688

Upper extremity addition, frame type socket, above elbow or elbow disarticulation

short

Frame typ sock above elb/dis

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6689

Upper extremity addition, frame type socket, shoulder disarticulation

short

Frame typ socket shoulder di

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6690

Upper extremity addition, frame type socket, interscapular-thoracic

short

Frame typ sock interscap-tho

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6691

Upper extremity addition, removable insert, each

short

Removable insert each

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	3 Date of Service Edit: Clinical	Clinical: Data
DME	2.0	3 Date of Service Edit: Clinical	Clinical: Data

L6692

Upper extremity addition, silicone gel insert or equal, each

short

Silicone gel insert or equal

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	3 Date of Service Edit: Clinical	Clinical: Data
DME	2.0	3 Date of Service Edit: Clinical	Clinical: Data

L6693

Upper extremity addition, locking elbow, forearm counterbalance

short

Lockingelbow forearm cntrbal

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

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

short

Elbow socket ins use w/lock

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	3 Date of Service Edit: Clinical	Nature of Equipment
DME	2.0	3 Date of Service Edit: Clinical	Nature of Equipment

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

short

Elbow socket ins use w/o lck

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	3 Date of Service Edit: Clinical	Nature of Equipment
DME	2.0	3 Date of Service Edit: Clinical	Nature of Equipment

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)

short

Cus elbo skt in for con/atyp

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

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)

short

Cus elbo skt in not con/atyp

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration

L6698

Addition to upper extremity prosthesis, below elbow/above elbow, lock mechanism, excludes socket insert

short

Below/above elbow lock mech

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	2.0	2 Date of Service Edit: Policy	Anatomic Consideration
DME	2.0	2 Date of Service Edit: Policy	Anatomic Consideration