2025 HCPCS code L6550

This HCPCS code represents a molded socket endoskeletal prosthetic system for upper limbs, specifically for shoulder disarticulation.

Refer to the official HCPCS coding guidelines for accurate coding and reimbursement.

Modifiers may be applicable depending on the specific circumstances of the service. Consult the HCPCS modifier guidelines for appropriate use.

Medical necessity for L6550 is established based on the presence of a shoulder disarticulation resulting in functional impairment. The prosthesis is required to improve mobility, activities of daily living, and overall quality of life. Documentation supporting the need for the prosthesis and its suitability for the patient is necessary.

The clinical responsibility for this procedure lies with the prosthetist or orthotist. This involves taking a plaster cast or mold of the patient's residual limb to create a custom-fitted socket.Selection of appropriate materials and components for the prosthesis, fabrication of the prosthesis, fitting, and adjustment of the prosthesis are all part of the clinical responsibility.

IMPORTANT For other molded socket upper extremity prostheses, see codes L6400 to L6570.

In simple words: This code is for a special artificial arm replacement made for people who have had their arm removed at the shoulder. It's designed to fit the remaining part of the arm snugly and has internal supports to make it strong and lightweight.

HCPCS code L6550 describes an endoskeletal upper extremity prosthesis with a molded socket and prosthetic tissue shaping.It is used for patients with shoulder disarticulation (surgical removal of the arm at the shoulder joint). The prosthesis consists of a socket which interfaces with the residual limb, a forearm, a wrist unit, and appropriate coverings.The endoskeletal design uses an internal pylon or tube-like structure for support, often covered with lightweight material such as plastic foam. The socket is typically created using a plaster mold of the patient's residual limb and can be made from various materials, including thermoplastic or elastic materials.

Example 1: A patient presents following a traumatic shoulder disarticulation amputation.The prosthetist takes a plaster cast of the residual limb, constructs the socket using thermoplastic material, and assembles the endoskeletal prosthesis with a lightweight foam covering., A patient undergoes a surgical shoulder disarticulation for cancer.Post-surgery, the prosthetist fits the patient with a custom-molded endoskeletal prosthesis to improve function and quality of life., A patient with a congenital limb deficiency receives an endoskeletal prosthesis with a molded socket to improve functionality. The prosthetist uses a combination of elastic and thermoplastic materials to create a comfortable socket.

Detailed medical history of the amputation, including date, cause, and level of amputation.Measurements and casts of the residual limb.Specifications of the prosthesis including materials, components, and design.Documentation of the fitting process and adjustments made.Patient education and training regarding prosthesis care and use.

** This code is specific to upper extremity prosthetics and should not be used for lower extremity or other types of prostheses. Always ensure proper documentation supporting the medical necessity and appropriateness of the prosthesis for the patient's specific needs.

  • Payment Status: Active
  • Specialties:Prosthetics and Orthotics
  • Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center
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