Articulating Digit(s) and Prosthetic Hands - Correct Coding - Revised
Joint DME MAC Publication
HCPCS code L6026 (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, EXCLUDES TERMINAL DEVICE(S)) describes a base code for a transcarpal/metacarpal or a partial hand disarticulation, myoelectric-controlled prosthesis which includes all necessary components besides the terminal device.
These are five external powered terminal devices which are available to be used with L6026.
1. L6715 TERMINAL DEVICE, MULTIPLE ARTICULATING DIGIT, INCLUDES MOTOR(S), INITIAL ISSUE OR REPLACEMENT
- HCPCS code L6715 describes one complete multiple articulating digit (finger or thumb) and the necessary motors. If more than one digit is billed, use the appropriate Units of Service (UOS) for code L6715. With initial issue, L6715 is only to be paired with L6026; however, 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.
2. L6880 ELECTRIC HAND, SWITCH OR MYOLELECTRIC CONTROLLED, INDEPENDENTLY ARTICULATING DIGITS, ANY GRASP PATTERN OR COMBINATION OF GRASP PATTERNS, INCLUDES MOTOR(S)
- HCPCS code L6880 describes a complete terminal device that can only be used with HCPCS code L6026 when a partial hand residual limb contains no digits. HCPCS code L6880 has all the following characteristics:
- Includes all necessary components. This L code describes a product that is all-inclusive. Billing of any additional features or functions used to describe a manufacturer's terminal device is considered unbundling.
- Comprised of five (5) articulating digits and the necessary motors.
- All grasp patterns are included in the L6880 HCPCS code language. The use of HCPCS code L6881 (AUTOMATIC GRASP FEATURE, ADDITION TO UPPER LIMB ELECTRIC PROSTHETIC TERMINAL DEVICE) would be considered unbundling.
- All switch/myoelectric controls are included in L6880 HCPCS code language. The use of code L6882 (Microprocessor control feature, addition to upper limb prosthetic terminal device) would be considered unbundling.
- Use of HCPCS code L6880 is only appropriate with externally powered custom fabricated sockets such as HCPCS codes L6026, L6920, L6925, L6930, L6935, L6940, L6945, L6950, L6955, L6960, L6965, L6970, and L6975.
- The use of HCPCS code L6715 on initial issue will be denied as unbundling. However, 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.
- If L6880 is under the manufacturer's warranty, HCPCS code L6715 as a replacement should not be billed to Medicare.
3. L7007 ELECTRIC HAND, SWITCH OR MYOELECTRIC CONTROLLED, ADULT
4. L7008 ELECTRIC HAND, SWITCH OR MYOELECTRIC CONTROLLED, PEDIATRIC
5. L7009 ELECTRIC HOOK, SWITCH OR MYOELECTRIC CONTROLLED, ADULT
Billing of more than one terminal device with HCPCS code L6026 is considered incorrect coding.
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 HCPCS codes L6026, L6715, L6880, or L7007-L7009 as these codes are considered all-inclusive. The use of HCPCS code L7499 on initial issue, with the any of the above HCPCS codes, is considered unbundling.
Correct coding is an essential element for correct claim payment. The Pricing, Data Analysis and Coding (PDAC) contractor maintains a variety of resources to assist suppliers in determining the appropriate code for Medicare billing. For questions about correct coding, contact the PDAC HCPCS Helpline at (877) 735-1326 during the hours of 9:30 am to 5:00 pm ET, Monday through Friday. You may also visit the PDAC website to chat with a representative, or select the Contact Us button at the top of the PDAC website for email, FAX, or postal mail information.
|Published on PDAC website
|Revised and republished. This article is a Correct Coding update to the December 21, 2011, article, which was retired due to HCPCS code changes.
|Revised due to the addition of the unbundling statement for L6882 and updated the PDAC contact information