2025 HCPCS code L6695
(Active) Effective Date: N/A Revision Date: N/A Prosthetics - Upper Extremity Prosthetic Additions L Codes (Orthotics and Prosthetics) Feed
Addition to upper extremity prosthesis, below elbow or above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism.
Medical necessity for the socket insert must be documented and should demonstrate that the insert is required to improve the fit, function, or comfort of the prosthesis, or to prevent skin breakdown.
The clinician's responsibility includes assessing the patient's needs, selecting the appropriate socket insert, ensuring proper fit and function of the prosthesis with the insert, and educating the patient on care and maintenance.
In simple words: This code covers a special insert made of gel or similar material that goes inside the part of an arm prosthesis that fits around the remaining limb (below or above the elbow). It makes the prosthesis more comfortable and helps prevent skin problems. This particular type is for prostheses without a locking mechanism.
This code covers the supply of a silicone gel, elastomeric, or equivalent socket insert for a below or above elbow prosthesis. The insert is either custom made from an existing mold or prefabricated in standard size. It is used to improve the fit and comfort of the socket, and is not for use with a locking mechanism.It reduces friction between the residual limb and the socket, thus enhancing comfort and preventing skin irritation.
Example 1: A patient with a below-elbow amputation experiences discomfort and skin irritation due to friction between the residual limb and the prosthetic socket. A silicone gel socket insert (L6695) is provided to improve comfort and reduce friction. The insert is custom fabricated from an existing mold to ensure a precise fit., A patient with an above-elbow amputation requires a new socket insert for their prosthesis. The prosthetist determines that a prefabricated elastomeric insert (L6695) of standard size is appropriate for the patient's needs and prosthetic design. The insert is provided to optimize the fit and comfort of the socket., An individual with a transradial amputation has a conventional, non-locking prosthesis. They report chafing at the proximal socket edge. A silicone gel insert (L6695) is fabricated to relieve the irritation.
Documentation should include the type of prosthesis, the reason for the socket insert (e.g., discomfort, skin irritation, improved fit), the material of the insert (e.g., silicone gel, elastomeric), whether it's custom fabricated or prefabricated, and the location (below or above elbow).
- Payment Status: Active
- Specialties:Prosthetists, Orthotists, Physiatrists, Physical Therapists
- Place of Service:Office, Outpatient Hospital, Prosthetics/Orthotics Facility