2025 HCPCS code L6400

Below-elbow molded socket endoskeletal prosthetic system, including soft prosthetic tissue shaping.

Adhere to all applicable HCPCS coding guidelines and payer-specific instructions.

Modifiers may apply depending on circumstances.For example, modifier 52 (reduced services) might be used if only a portion of the procedure was performed.Consult current HCPCS guidelines for appropriate modifier application.

Medical necessity is established when the below-elbow endoskeletal prosthesis is deemed essential for restoring functional use of the upper extremity and improving the patient's quality of life following a transradial amputation. The justification should include clinical rationale supporting the choice of this specific type of prosthesis over alternatives.

The clinical responsibility involves taking a plaster mold of the patient's residual limb, fabricating the custom-molded socket (potentially using thermoplastic or elastic materials), assembling the endoskeletal components (including the pylon, forearm, wrist unit, and coverings), and fitting the prosthesis to the patient.Post-fitting adjustments and follow-up care may also be included.

IMPORTANT For other molded socket upper extremity prostheses, refer to codes L6450 to L6570.

In simple words: This code covers the creation and fitting of a special artificial arm for someone who has had their arm amputated below the elbow.This artificial arm has an inner support structure and a custom-made socket to fit the remaining part of the arm. It also includes shaping to make it look more natural.

This HCPCS code, L6400, represents a below-elbow molded socket endoskeletal prosthetic system that incorporates soft prosthetic tissue shaping.The system consists of a socket custom-molded to the patient's residual limb after a transradial amputation (surgical removal of the arm between the elbow and wrist), an internal support structure (pylon), a forearm component, a wrist unit, and appropriate coverings.Materials may include thermoplastic or elastic for the socket and lightweight materials such as plastic foam for coverings. The code encompasses the fabrication and fitting of the entire prosthetic system.

Example 1: A patient presents following a transradial amputation due to a work-related accident. The prosthetist takes a plaster cast of the residual limb to create a custom-molded socket for an endoskeletal prosthetic system.The system is fabricated, fitted, and adjusted for optimal function and comfort., A patient with a congenital limb difference requires a below-elbow prosthesis.The prosthetist designs and fabricates a custom molded socket endoskeletal system with soft tissue shaping to improve cosmetic appearance and functionality., A patient who underwent a transradial amputation due to trauma requires a functional below-elbow prosthesis for work and daily activities.The prosthetist creates a durable, lightweight prosthesis using L6400 guidelines.The patient receives training on proper use and care of the prosthesis.

Detailed documentation should include the patient's medical history, including the type and date of amputation;images of the residual limb;specifications of the materials used in the prosthesis;measurements of the socket and other components;records of fittings and adjustments; and patient instructions for use and care.Documentation should also include information regarding the patient's functional goals and the prosthesis's success in achieving these goals.

** This code may be subject to payer-specific policies and requirements regarding coverage, reimbursement, and prior authorization. Always consult with the specific payer for the most up-to-date information.

  • Payment Status: Active
  • Modifier TC rule: The application of a Technical Component (TC) modifier is not typically applicable to this code, as it represents a comprehensive prosthetic system.
  • Specialties:Prosthetics, Orthopedics, Physical Medicine and Rehabilitation
  • Place of Service:Office, Ambulatory Surgical Center
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