Correct Billing for Upper Limb Prosthesis with L6895 instead of L7499 - Revised

The Durable Medical Equipment Medicare Administrative Contractors (DME MACs), have discovered suppliers billing Healthcare Common Procedure Coding System (HCPCS) code L7499, (UPPER EXTREMITY PROSTHESIS, NOT OTHERWISE SPECIFIED) for upper limb prosthetic cosmetic features such as: coloring, veins, hair, etc. Suppliers should be billing HCPCS code L6895 (ADDITION TO UPPER EXTREMITY PROSTHESIS, GLOVE FOR TERMINAL DEVICE, ANY MATERIAL, CUSTOM FABRICATED).

HCPCS code L6895 is the appropriate code to bill for a prosthetic cosmetic glove including matching color, hair, skin, and wrinkles. Suppliers should not bill using HCPCS code L7499 for the cost of the additional cosmetic features. The long narrative description of HCPCS code L6895 includes "ANY MATERIAL" and therefore includes all of these cosmetic features.

If suppliers believe the addition of these features changes the narrative description, they are encouraged to seek a new HCPCS code through CMS. CMS maintains HCPCS Level II Codes. This includes decisions regarding code additions, revisions, and deletions. Visit the Healthcare Common Procedure Coding System (HCPCS) page on CMS’ website to find details about how to submit a HCPCS Level II coding application to CMS through MEARISTM.

Revision History