The Centers for Medicare & Medicaid Services (CMS) set reimbursement rates for the new lower-limb orthosis and prosthesis codes and partial hand prosthesis codes introduced last year through CMS’ Second Biannual 2025 Non-Drug and Non-Biological Items and Services HCPCS Level II code application review cycle.
The codes, description, and average rate of reimbursement are as follows:
- L-2221
Addition to lower extremity orthosis, ankle system, microprocessor-controlled feature plantarflexion and/or dorsiflexion, includes power source, $1,889.92
- L-5657
Addition to lower extremity prosthesis, manual/automated adjustable air, fluid, gel or equal socket insert for limb volume management, any materials, $306.30
- L-5992
All lower extremity prosthesis, foot shell for modular foot/non-solid ankle cushion heel (SACH) replacement only, $127.11
- L-6028
Partial hand, finger, and thumb prosthesis without prosthetic digit(s)/thumb, amputation at metacarpal level, including flexible or non-flexible interface, molded to patient model, including palm, for use without external power and/or passive prosthetic digit/thumb, not including inserts described by L-6692, $1,944.02
- L-6029
Upper extremity addition, test socket/interface, partial hand including fingers, $332.06
- L-6030
Upper extremity addition, external frame, partial hand including fingers, $751.19
- L-6031
Replacement socket/interface, partial hand including fingers, molded to patient model, for use with or without external power, $1,585.87
- L-6032
Addition to upper extremity prosthesis, partial hand including fingers, ultralight material (titanium, carbon fiber or equal), $375.52
- L-6033
Addition to upper extremity prosthesis, partial hand including fingers, acrylic material, $451.20
- 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, $388.80
- 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, $1,591.25
- 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, $1,591.25
- L-6037
Immediate post-surgical or early fitting, application of initial rigid dressing, including fitting alignment and suspension of components, and one cast change, partial hand including fingers, $1,583.09
- 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, $364.48
- 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, $2,106.26
To read the document, “CMS HCPCS Level II Final Coding, Benefit Category, and Payment Determinations_B2,2025,” visit the CMS website.
