2025 HCPCS code L6570

Interscapular thoracic amputation, molded socket, endoskeletal system, including soft prosthetic tissue shaping.

Use L codes to represent the supply of orthotics and prosthetics. L codes also cover fitting, adjustment, and other associated services. These should not be billed separately.

Medical necessity must be established for the L6570 prosthesis. This usually involves demonstrating the functional impairment caused by the amputation and how the prosthesis will improve the patient's ability to perform daily activities.

This code is reported by the supplier who provides and fits the upper extremity prosthesis.

IMPORTANT For a below-elbow amputation prosthesis, use L6400. For an elbow disarticulation prosthesis, use L6450. For an above-elbow amputation prosthesis, use L6500. For a shoulder disarticulation prosthesis, use L6550.

In simple words: This code covers an artificial arm and shoulder replacement for patients who have had their entire arm and shoulder removed. It's custom-fit and includes shaping the artificial soft tissue to look natural.

This code covers the supply of an endoskeletal prosthesis molded to fit a patient who has had an interscapular thoracic amputation (removal of the entire arm and shoulder girdle, including the humerus, scapula, and part of the clavicle). It also includes shaping the outer soft tissue of the prosthesis.

Example 1: A patient undergoes an interscapular thoracic amputation due to cancer. They require an L6570 prosthesis to replace the missing arm and shoulder., Following a traumatic accident, a patient's arm and shoulder are completely removed. An L6570 prosthesis is provided to restore some functionality., A patient with a congenital defect has a missing arm and shoulder.They are fitted with an L6570 prosthesis to improve their quality of life.

Documentation should support the medical necessity of the prosthesis, including details of the amputation, clinical evaluation, and fitting process.

  • Specialties:Prosthetics, Orthotics, Physical Medicine and Rehabilitation, Surgical Oncology
  • Place of Service:Outpatient, Prosthetist Office
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