In a joint news update, the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) released correct Healthcare Common Procedure Coding System (HCPCS) billing details for upper-limb prostheses, partial hand prostheses, and scoliosis braces.
Upper-Limb Prostheses
The DME MACs noted that suppliers billing HCPCS code L-7499 (upper extremity prosthesis, not otherwise specified) for cosmetic features such as coloring, veins, hair, etc.) should be billing L-6895 (addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated).
“The long narrative description of HCPCS code L-6895 includes ‘any material’ and therefore includes all of these cosmetic features,” the update read. “If suppliers believe the addition of these features changes the narrative description, they are encouraged to seek a new HCPCS code through CMS [the Centers for Medicare & Medicaid Services].”
Partial Hand Prostheses
In the First Biannual, 2025 HCPCS Coding Cycle in August, CMS published its coding decision that partial-hand codes L-6000 (partial hand, thumb remaining), L-6010 (partial hand, little and/or ring finger remaining), and L-6020 (partial hand, no finger remaining) will remain effective.
CMS also announced that it will revise the long description of HCPCS code L-6028 and make it invalid for billing to Medicare for dates of service on or after October 1.
In the latest news update, CMS specified it plans to reintroduce a new description for L-6028 in the Second Biannual (B2), 2025 HCPCS Coding Cycle. The revised description as follows: 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).
The code description until October 1 is as follows: partial hand including fingers, flexible or non-flexible interface, endoskeletal system, molded to patient model, for use without external power, not including inserts described by L-6692.
HCPCS codes L-6000, L-6010, and L-6020 will remain effective until L-6028 is reintroduced as a valid code.
The joint publication goes on to say that body-powered partial hand prostheses are correctly coded when the amputation matches one of the partial hand prosthetic body-powered codes (L-6000, L-6010, or L-6020). “Per CMS guidance, these codes are equivalent to L-6028 as a partial hand base code and can utilize applicable additions. The base code alone may not fully describe the delivered prosthesis. L-codes referred to as ‘addition’ codes can be used to describe features and functions not found in the base L-code.
“The available L-codes are either specific to partial hand amputations (e.g., L-6030, L-6035, L-6038) or to nonspecific levels of upper-limb amputations (e.g., L-6692, L-6698). The use of L-codes with specific amputation levels proximal to partial hand level would be considered incorrect coding.
HCPCS code L-7499 (upper extremity prosthesis, not otherwise specified) must not be used to bill for any features or functions included in the base L-code nor should it be used when a specific L-code exists.”
Scoliosis Bracing
The DME MACs and the Pricing, Data Analysis and Coding Contractor reminded suppliers that there are seven base HCPCS codes available to fully describe scoliosis braces. Five codes (L-1005, L-1006, L-1007, L-1300, and L-1310) are all inclusive and are not billed with addition codes. Two codes (L-1000 and L-1200) have specific addition codes which can be used to describe components utilized to support or resist the progression of the users specific spinal curve pattern.
To read “Correct Billing for Upper Limb Prosthesis with L6895 instead of L7499–Revised,” visit the CGS website.
To read the “Scoliosis Brace–Correct Coding–Revised,” visit the CGS website.
To read the“2025 HCPCS Code Update–October Edition–Correct Coding,” visit the CGS website.
