2025 HCPCS code 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.
Modifiers such as LT (left side) or RT (right side) may be applicable.
Medical necessity must be established by demonstrating the patient's functional impairment due to the amputation and how the prosthesis will improve their ability to perform activities of daily living. Documentation should support the patient's ability to use and benefit from the device.
In simple words: This code covers a powered prosthetic arm for patients with an amputated elbow joint. It's custom-fit with a mold, has locking hinges for the forearm, and uses electrical signals from the remaining arm muscles to control the prosthetic hand. It includes the batteries and charger.
This code covers an externally powered upper limb prosthesis for elbow disarticulation, featuring a molded inner socket, removable humeral shell, outside locking hinges for forearm locking, Otto Bock or equivalent electrodes and cables for myoelectric terminal device control, including two batteries and a charger.
Example 1: A patient with a left elbow disarticulation requires an externally powered prosthesis with myoelectric control to perform daily activities. Code L6945 is used for the prosthetic arm., A patient with a right elbow disarticulation following a traumatic injury needs a prosthesis that allows for precise control of the terminal device. Code L6945 is used, along with modifiers RT (right side) for the supply of the prosthesis., Following an elbow disarticulation, a patient requires an externally powered prosthetic arm with a myoelectric hand and a flexible elbow joint. L6945 is billed for the prosthesis.
Documentation should include details of the amputation level (elbow disarticulation), the type of prosthesis (externally powered, myoelectric control), the components included (molded inner socket, removable humeral shell, electrodes, cables, batteries, charger), and medical justification for the device.
- Specialties:Prosthetics, Orthopedics, Rehabilitation Medicine
- Place of Service:Outpatient Hospital, Physician's Office, Prosthetics Clinic.