The Centers for Medicare & Medicaid Services (CMS) published the annual fourth quarter update to the Healthcare Common Procedure Coding System (HCPCS) Level II code set, which includes several new O&P-related codes. The code changes will be effective on October 1.
The new codes are:
- L-1007: Scoliosis orthosis, sagittal-coronal control provided by a rigid lateral frame, extends from axilla to trochanter, includes all accessory pads, straps, and interface, custom fabricated
- L-5657: Addition to lower extremity prosthesis, manual/automated adjustable air, fluid, gel or equal socket insert for limb volume management, any materials
- L-6034: Partial hand, finger, and thumb prosthesis without prosthetic digit(s)/thumb, amputation at distal to metacarpal joint, including flexible or non-flexible interface, molded to patient model, for use without external power and/ or passive prosthetic digit/thumb, not including inserts described by L-6692
- L-6035: Single prosthetic digit, mechanical, can include metacarpophalangeal (mcp), proximal interphalangeal (pip), and/or distal interphalangeal (dip) joint(s), with or without locking mechanism, can include flexion or extension assist, any material, attachment, initial issue or replacement
- L-6036: Prosthetic thumb, mechanical, can include metacarpophalangeal (mcp), interphalangeal (ip) joint(s), with or without locking mechanism, can include flexion or extension assist, any material, attachment, initial issue or replacement
- L-6038: Addition to single prosthetic digit or thumb, mechanical, attachment, multiaxial and/or internal/external rotation/abduction/adduction mechanism, with or without locking feature, any material
- L-6039: Passive prosthetic digit or thumb prosthesis not including hand restoration partial hand, full or partial, custom made, any material, initial or replacement, per single passive prosthetic digit or thumb
CMS has not established fees for the new codes, noting that they will be presented at a future Coding Workgroup public meeting or addressed in a future coding cycle.
To download the HCPCS Quarterly Update, visit the CMS website.
