2025 HCPCS code L6450
(Active) Effective Date: N/A Revision Date: N/A Prosthetics - Molded Socket Endoskeletal Prosthetic System, Upper Limbs Prosthetic Procedures Feed
This HCPCS code represents an endoskeletal prosthetic system with a molded socket and prosthetic tissue shaping for elbow disarticulation or amputation through the elbow joint.
Modifiers may be applicable depending on the circumstances of service, such as the use of additional materials or services (e.g., modifier 22 for increased procedural services, modifier 52 for reduced services).
Medical necessity for L6450 is established by the presence of an elbow disarticulation or amputation requiring prosthetic replacement for functional and/or cosmetic reasons.Documentation should support the need for this specific type of prosthesis based on the patient's individual needs and functional limitations.
The clinical responsibility for this procedure involves taking a plaster mold of the patient's residual limb, designing and fabricating the custom-fit socket and endoskeletal prosthesis, and fitting the prosthesis to the patient.Post-operative care and adjustments may also be included.
In simple words: This code covers a special artificial arm for people who have had their arm amputated at the elbow. It's made with a custom-fitted socket, an internal support structure, and coverings for a natural look and feel.
HCPCS code L6450 describes an endoskeletal upper extremity prosthesis for a patient with an elbow disarticulation. The residual limb connects with the prosthesis at the socket.A plaster mold of the patient's stump is typically used to create the molded socket, which can be constructed from various materials such as thermoplastic or elastic. The endoskeletal prosthesis derives support from an internal pylon or tube-like device.The prosthesis includes a socket, forearm, wrist unit, and appropriate coverings, often a lightweight material like plastic foam.
Example 1: A 45-year-old male sustains a traumatic elbow amputation in a workplace accident.He requires an endoskeletal prosthesis with a custom-molded socket to restore function and improve quality of life. Code L6450 is used to bill for the creation and fitting of this prosthetic device., A 70-year-old female undergoes an elective elbow disarticulation due to a malignant tumor.Following surgery, she requires a custom-fabricated L6450 prosthesis to achieve optimal function and cosmetic appearance.This procedure will be billed using code L6450., A 22-year-old male experiences a limb loss from a motorcycle accident and is fitted with an endoskeletal prosthesis with a molded socket, requiring soft prosthetic tissue shaping.The physician uses code L6450 to represent the procedure for billing purposes.
Detailed medical records including pre-operative assessment (e.g., limb measurements, photos of the residual limb), surgical report, prosthesis fabrication notes (materials used, design specifications), fitting notes, and post-operative follow-up care.
** This code encompasses the creation and fitting of a complete endoskeletal prosthesis.Separate codes may be necessary for additional components or services such as custom-fabricated liners, suspension systems, or specialized coverings.Consider local payer guidelines for specific reimbursement policies.
- Payment Status: Active
- Specialties:Prosthetics and Orthotics, Surgery (Orthopedic, Trauma)
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center