2025 HCPCS code L6500
(Active) Effective Date: N/A Revision Date: N/A Prosthetic Procedures - Molded Socket Endoskeletal Prosthetic System, Upper Limbs Prosthetic Procedures Feed
This HCPCS code represents an endoskeletal prosthetic system with a molded socket and soft prosthetic tissue shaping for above-elbow or transhumeral amputations.
Modifiers may be applicable depending on the circumstances of service and may include modifiers for reduced services, multiple procedures, or other specific circumstances. Always consult the appropriate coding guidelines for accurate modifier application.
Medical necessity for L6500 is established by the presence of an above-elbow or transhumeral amputation, the need for prosthetic replacement to restore or improve upper limb function and mobility, and the lack of alternative means to achieve similar functional outcomes.The physician's documentation must support the medical necessity, indicating that the prosthesis is the most appropriate and effective intervention for the patient's specific condition.
The clinical responsibility involves taking a plaster mold of the patient's residual limb, selecting appropriate materials for the socket (such as thermoplastic or elastic), constructing the endoskeletal framework, assembling the prosthesis components (socket, forearm, wrist unit, and coverings), and ensuring proper fit and functionality.
In simple words: This code covers a special artificial arm for people who have lost their arm above the elbow.It's custom-made to fit the remaining part of the arm and includes a socket, forearm, wrist, and covering. The artificial arm has an internal support structure.
HCPCS code L6500 describes an endoskeletal upper extremity prosthesis designed for patients with above-elbow amputations.The prosthesis comprises a molded socket that interfaces with the residual limb, an internal pylon or tube-like support structure, a forearm component, a wrist unit, and appropriate coverings (often lightweight materials like plastic foam). The socket is created using a plaster mold of the patient's residual limb, and various materials (such as thermoplastic or elastic) may be used in its construction.The code encompasses soft prosthetic tissue shaping as part of the overall fabrication process. This is used for transhumeral amputations (surgical removal of the arm between the elbow and shoulder).
Example 1: A patient presents following a transhumeral amputation due to a traumatic injury.A custom-fit endoskeletal prosthesis with a molded socket (L6500) is fabricated to restore upper limb function., A patient undergoes a surgical above-elbow amputation due to a malignant tumor. Post-surgery, an endoskeletal prosthetic system with a molded socket and soft tissue shaping (L6500) is fitted to improve the patient's quality of life and functional independence., A patient with a congenital limb deficiency requires a custom-designed endoskeletal prosthesis (L6500) with a molded socket to enable them to perform daily activities.
Detailed medical history, including the cause and date of amputation, type of amputation (above-elbow or transhumeral),photographs or detailed measurements of the residual limb,specifications of the materials used in the prosthesis (socket material, covering material), and a description of the components included (forearm, wrist unit). Documentation should also include the fitting and adjustment process, and a follow-up assessment to evaluate the success of the prosthesis.
** This code is specific to endoskeletal prostheses with molded sockets.Other codes exist for different types of upper extremity prostheses.
- Payment Status: Active
- Specialties:Prosthetics and Orthotics, Surgery (Orthopedic, Vascular), Rehabilitation Medicine
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center