2025 HCPCS code L6250

Above elbow, molded double wall socket, internal locking elbow, forearm.

The HCPCS code L6250 should be used to report the provision of an above-elbow prosthesis with a molded double-wall socket and an internal locking elbow mechanism. It is important to ensure the documentation supports the medical necessity of the device.

Medical necessity is established by demonstrating the functional limitations imposed by the amputation and how the prosthesis will improve the patient's ability to perform daily activities.

The clinician is responsible for taking a mold of the patient's stump, fabricating the socket from thermoplastic or elastic material, and ensuring the proper fit and function of the prosthesis. They must also educate the patient on the use and care of the device.

In simple words: This code covers an artificial arm and hand for people who have had their arm amputated above the elbow. It includes a custom-fitted socket and a special elbow that can be locked in place.

This code represents an arm and hand prosthesis for patients with a transhumeral (above elbow) amputation. It includes a molded double-wall socket and internal locking elbow mechanisms. The internal locking mechanism allows the patient to lock the prosthetic elbow in a flexed position, and the double-wall socket provides stability and control.

Example 1: A patient with a transhumeral amputation due to trauma requires a prosthesis with a locking elbow for increased stability during daily activities., A patient with a congenital above-elbow limb deficiency needs a custom-fitted prosthesis to improve functionality and independence., A patient undergoing revision surgery for an existing above-elbow prosthesis requires a new socket and internal locking elbow mechanism to address changes in limb volume or function.

Documentation should include the type of amputation, level of amputation, measurements of the residual limb, the type of socket and elbow mechanism used, and any modifications made to the prosthesis. Justification for medical necessity should also be included.

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