The Centers for Medicare & Medicaid Services (CMS) released preliminary decisions from the Healthcare Common Procedure Coding System (HCPCS) Coding Workgroup for the latest coding cycle. The workgroup proposed four new upper-limb prosthetic device codes and suggested combining two others to address Revofit’s shared lamination kit for prostheses and offloading orthoses. If approved, the code changes would be effective on October 1. CMS is hosting a public meeting to discuss the proposal on June 2.
Description of the new codes are as follows:
- Single digit, per articulation, mechanical, metacarpophalangeal (mcp), proximal interphalangeal (pip), and/or distal interphalangeal (dip) joint(s), with or without locking mechanism, any material, attachment, initial issue or replacement
- Thumb, per articulation, mechanical, metacarpophalangeal (mcp) and interphalangeal (ip) joint, with or without locking mechanism, any material, attachment, initial issue or replacement
- Addition to digit or thumb, per articulation, attachment, multiaxial and/or internal/external rotation/abduction/adduction mechanism, with or without locking feature, any material
- Passive digit or thumb, full or partial, custom made, any material, initial or replacement, per single digit or thumb
The workgroup proposed eliminating L-5783 (addition to lower extremity, user adjustable, mechanical, residual limb volume management system) and L-7406 (addition to upper extremity, user adjustable, mechanical, residual limb volume management system) and replacing them with a new code that applies to both prostheses and orthoses that use volume management systems and includes lamination as part of the code.
The new code (addition to extremity, user adjustable, mechanical, custom fabricated, limb volume management system (including lamination kit, etc.) would describe upper- and lower-limb prostheses from RevoFit and would have the same fee schedule amount as L-5783 and L-7406. “The RevoFit Systems for lower-limb prostheses and for upper-limb prostheses and RevoFit System for lower-limb offloading orthoses use the same lamination kit,” according to the document.
Pending establishment of a fee schedule amount for, the payment amounts for the new codes would be based on the provider’s “individual consideration of the item and judgment of a reasonable payment amount, which, at a minimum, includes a review of the costs of labor and material used in constructing the equipment.”
To read the proposal details, visit the CMS First Biannual 2025 Healthcare Common Procedure Coding System (HCPCS) Public Meeting Agenda on the CMS website.
