2025 HCPCS code L6950
(Active) Effective Date: N/A Revision Date: N/A Prosthetic Procedures - External Power Upper Limb Prosthetics Orthopedic Devices Feed
Supply of an externally powered upper extremity prosthesis with switch control.
Modifiers LT (left) and RT (right) may be appended as clinically indicated.
Medical necessity is established when the prosthesis is deemed essential for the patient to perform activities of daily living and improve their quality of life. The patient must demonstrate the ability to operate the device effectively and the device must match their needs.
Supply of the externally powered upper extremity prosthesis.Assessment of the patient's needs and fitting of the prosthesis.
In simple words: This code covers the cost of a special artificial arm for people who have lost their arm above the elbow.The arm is powered by batteries and controlled by a switch.The cost includes the arm itself, a battery charger and extra batteries.
This HCPCS code, L6950, encompasses the provision of an externally powered upper extremity prosthesis designed for patients with above-elbow amputations.The prosthesis features a molded inner socket, a removable humeral shell, and an internal locking elbow mechanism. Control of the terminal device (artificial hand or hook) is facilitated by an Otto Bock or equivalent switch and accompanying cables.The supply package includes two batteries and a charger; these components are integral to the prosthesis and should not be billed separately.Medicare coverage is contingent upon documentation confirming the patient's ability to operate the prosthesis and its suitability for daily living activities.
Example 1: A patient presents post-surgical above-elbow amputation.Following rehabilitation, the patient is assessed and fitted with the L6950 prosthesis. This scenario involves detailed assessment, fitting, and training on prosthesis use., A patient with a pre-existing above-elbow amputation requires a replacement prosthesis due to wear and tear. The L6950 prosthesis is chosen and fitted, and patient training is updated., A patient with a traumatic above-elbow amputation, after initial wound healing and rehabilitation, is deemed a candidate for prosthetic fitting. The L6950 prosthesis, considered suitable based on patient needs, is selected, fitted, and patient training is provided.
Comprehensive medical history, including the reason for amputation;Physician's order specifying the type of prosthesis;Detailed assessment of the patient's residual limb;Documentation of the fitting process, including measurements and adjustments; Patient training records;Photographs of the fitted prosthesis.
** Coverage determination may vary depending on the payer. Always check with the specific payer for coverage policies and requirements.
- Payment Status: Active
- Specialties:Prosthetics, Orthopedics, Physical Medicine and Rehabilitation
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center