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August 22, 2019

Correct Coding - Partial Hand Prostheses

Joint DME MAC Publication

A recent analysis of upper extremity prostheses claims submitted with the following HCPCS codes revealed incorrect coding of:

These codes describe products that are used for three distinct types of amputations including the digit(s) and metacarpal-phalangeal (MCP) joint of missing digit(s).

These products have the capacity for finger opening and closing driven by body-power only. 

Body-powered partial hand prostheses are correctly coded when the amputation matches one of the partial hand prosthetic body-powered codes (L6000, L6010, L6020).   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 or to non-specific levels of upper extremity amputations.  The use of L-codes with specific amputation levels proximal to partial hand level would be considered incorrect coding.

HCPCS code L7499 (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. 

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

Publication history

August 22, 2019      Originally Published

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