Coding Updates for Articulating Digits, Prosthetic Hands

The Centers for Medicare and Medicaid Services recently released two new codes as part of their annual 2012 HCPCS release.  Below is information from CGS on the two new codes that became effective on January 1, 2012, as well as information relating to proper coding when using a combination of billing codes or modifiers.

  • L6715 TERMINAL DEVICE, MULTIPLE ARTICULATING DIGIT, INCLUDES MOTOR(S), INITIAL ISSUE OR REPLACEMENT
  • L6880 ELECTRIC HAND, SWITCH OR MYOELECTRIC CONTROLLED, INDEPENDENTLY ARTICULATING DIGITS, ANY GRASP PATTERN OR COMBINATION OF GRASP PATTERNS, INCLUDES MOTOR(S).

HCPCS code L6715 describes multiple articulating digit(s) (fingers and/or thumb) which are used on initial issue when paired with a partial hand base procedure code (L6000, L6010, L6020).  The articulating digit(s) can also be used as a “replacement digit(s)” with the use of the RB modifier as part of a prosthetic repair.  The following base procedure codes include a custom fabricated socket.

  • L6000  PARTIAL HAND, THUMB REMAINING   
  • L6010 PARTIAL HAND, LITTLE AND/OR RING FINGER REMAINING                               
  • L6020 PARTIAL HAND, NO FINGER REMAINING 

HCPCS Code L6025 (TRANSCARPAL/METACARPAL OR PARTIAL HAND DISARTICULATION PROSTHESIS, EXTERNAL POWER, SELF-SUSPENDED, INNER SOCKET WITH REMOVABLE FOREARM SECTION, ELECTRODES AND CABLES, TWO BATTERIES, CHARGER, MYOELECTRIC CONTROL OF TERMINAL DEVICE) describes a complete prosthesis.  This base procedure code includes all necessary components.  This base procedure code includes a custom fabricated socket.   The use of L6715 on initial issue will be denied as unbundling.

HCPCS code L6880 describes a complete hand prosthesis, which consists of the terminal device, all articulating digits and motors.  This base procedure code does not include a custom fabricated socket.  This base procedure code includes all necessary components.   The use of L6715 on initial issue will be denied as unbundling.

HCPCS code L7499 (UPPER EXTREMITY PROSTHESIS, NOT OTHERWISE SPECIFIED) must not be used for  the billing of any additional features or components, programming, adjustment, etc. with L6025 or L6880 as these codes are considered all-inclusive.  The use of L7499 on initial issue will be denied as unbundling.

The above information was gathered from CGS, please click here for additional information.

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This entry was posted in Orthotics and Prosthetics, Prosthetist, re provider, Regulatory and tagged , , , , , . Bookmark the permalink.

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