Retired - Correct Coding - Articulating Digit(s) and Prosthetic Hands

Two new codes were released by the Centers for Medicare & Medicaid Services as part of the HCPCS 2012 Annual Release. These codes are effective for dates of service on or after January 1, 2012. The new codes are:

• 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.

For questions about correct coding, contact the Pricing, Data Analysis and Coding (PDAC) Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form located on the PDAC website: https://www.dmepdac.com/