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2025 HCPCS code L6955

Externally powered upper limb prosthesis with a molded inner socket, removable humeral shell, internal locking elbow, and myoelectric control of terminal device for above-elbow amputations.

Medical necessity for the L6955 prosthesis must be established based on the patient's individual needs and functional limitations. The documentation should demonstrate how the prosthesis will improve the patient's ability to perform activities of daily living and enhance their overall quality of life.

The clinician is responsible for ensuring the proper fit and function of the prosthesis, training the patient on its use, and documenting the medical necessity for the device. This includes evaluating the patient's muscle strength, range of motion, and overall physical condition, and selecting the appropriate components to meet the patient's individual needs.

IMPORTANT:L6950 (similar prosthesis with switch control), L6250 (above elbow prosthesis with molded double wall socket and internal locking elbow), L6500 (above elbow prosthesis with molded socket and endoskeletal system)

In simple words: This is an advanced prosthetic arm for people who have lost their arm above the elbow. It's powered by batteries and uses the person's muscle signals to control the hand. It's custom-fitted with a special socket and has a locking elbow joint for better control and stability.

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. This prosthesis is designed for individuals with above-elbow amputations. It features a molded inner socket for a comfortable and customized fit, a removable humeral shell, and an internal locking elbow for stability. The prosthesis uses Otto Bock or equivalent electrodes and cables to control the terminal device (hand replacement) through myoelectric signals generated by the user's muscles. It includes two batteries and a charger for the external power source.

Example 1: A patient with a traumatic above-elbow amputation requires a prosthesis that allows them to perform daily activities such as eating, dressing, and grooming. The L6955 prosthesis with myoelectric control provides the necessary functionality and control for these tasks., A patient with a congenital above-elbow limb deficiency needs a prosthesis that allows them to participate in recreational activities. The L6955 prosthesis offers the power and control needed for activities such as sports or playing musical instruments., A patient with a recent above-elbow amputation due to cancer requires a prosthesis to improve their quality of life and independence. The L6955 prosthesis with its customized fit and advanced technology provides a comfortable and functional solution.

Documentation should include the medical necessity for the prosthesis, the patient's functional limitations, the type of amputation, and the specific components and features of the L6955 prosthesis. It should also include details about the fitting process, patient training, and any necessary adjustments.

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