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2025 HCPCS code L6694

Supply of a custom-fabricated or prefabricated socket insert for a below or above elbow prosthesis, using silicone gel, elastomer, or similar material; for use with a locking mechanism.

Follow HCPCS coding guidelines for prosthetics and orthotics. Ensure correct code selection based on the material and locking mechanism.

Modifiers may be applicable depending on the circumstances of service. Consult the most up-to-date modifier guidelines.

Medical necessity for L6694 is established when a patient with an upper limb prosthesis requires an additional socket insert due to skin irritation, poor fit, or to improve comfort and function. The insert must be medically necessary to improve the prosthetic fitting, reduce skin breakdown, and improve the patient's quality of life.

The clinical responsibility lies with the prosthetist or orthotist who assesses the patient's needs, fabricates or selects the appropriate socket insert, and ensures proper fitting and function.

IMPORTANT:L6695 (socket insert without locking mechanism), L6696 (socket insert for congenital or atypical traumatic amputees), L6697 (socket insert for other than congenital or atypical traumatic amputees)

In simple words: This code covers the cost of a special cushion or liner that goes inside a prosthetic arm socket.It's made of soft material like silicone and is used to make the artificial arm more comfortable and fit better. It works with arm sockets that have a locking feature.

This HCPCS code, L6694, encompasses the provision of a socket insert designed for below-elbow or above-elbow prostheses.The insert material is silicone gel, elastomeric material, or an equivalent, and is either custom-made from an existing mold or prefabricated.A key feature is its compatibility with a locking mechanism present in the prosthetic socket. The insert's function is to improve the fit and comfort of the prosthesis by reducing friction between the residual limb and the socket.This code specifically applies to inserts used with locking mechanisms; different codes exist for sockets without such mechanisms or for specific patient populations (e.g., congenital amputees).

Example 1: A patient with a below-elbow amputation receives a new prosthesis.The prosthetist fits a silicone gel socket insert (L6694) to enhance comfort and reduce friction., A patient with an above-elbow amputation experiences skin irritation from their prosthesis. The prosthetist replaces their existing liner with a custom-fabricated silicone insert (L6694) designed for use with the locking mechanism of their socket., During routine maintenance, a patient's prefabricated silicone gel socket insert (L6694) shows significant wear and needs replacing. The prosthetist orders a new one to ensure continued proper fit and function of the prosthesis.

* Physician's order for the prosthesis and liner.* Documentation of the patient's limb measurements.* Documentation of the type and material of the socket insert (silicone gel, elastomer, etc.).* Indication that the insert is compatible with the prosthesis's locking mechanism.* Documentation of the fitting and assessment of the prosthesis's function.

** This code is specific to socket inserts used with locking mechanisms.Always verify the type of socket and insert before coding.

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