HCPCS Range Upper Extremity Prosthetic Additions

• 1 Upper extremity additions, polycentric hinge, pair ( L6600 )

• 2 Upper extremity additions, single pivot hinge, pair ( L6605 )

• 3 Upper extremity additions, flexible metal hinge, pair ( L6610 )

• 4 Addition to upper extremity prosthesis, external powered, additional switch, any type ( L6611 )

• 5 Upper extremity addition, disconnect locking wrist unit ( L6615 )

• 6 Upper extremity addition, additional disconnect insert for locking wrist unit, each ( L6616 )

• 7 Upper extremity addition, flexion/extension wrist unit, with or without friction ( L6620 )

• 8 Upper extremity prosthesis addition, flexion/extension wrist with or without friction, for use with external powered terminal device ( L6621 )

• 9 Upper extremity addition, spring assisted rotational wrist unit with latch release ( L6623 )

• 10 Upper extremity addition, flexion/extension and rotation wrist unit ( L6624 )

• 11 Upper extremity addition, rotation wrist unit with cable lock ( L6625 )

• 12 Upper extremity addition, quick disconnect hook adapter, Otto Bock or equal ( L6628 )

• 13 Upper extremity addition, quick disconnect lamination collar with coupling piece, Otto Bock or equal ( L6629 )

• 14 Upper extremity addition, stainless steel, any wrist ( L6630 )

• 15 Upper extremity addition, latex suspension sleeve, each ( L6632 )

• 16 Upper extremity addition, lift assist for elbow ( L6635 )

• 17 Upper extremity addition, nudge control elbow lock ( L6637 )

• 18 Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow ( L6638 )

• 19 Upper extremity additions, shoulder abduction joint, pair ( L6640 )

• 20 Upper extremity addition, excursion amplifier, pulley type ( L6641 )

• 21 Upper extremity addition, excursion amplifier, lever type ( L6642 )

• 22 Upper extremity addition, shoulder flexion-abduction joint, each ( L6645 )

• 23 Upper extremity addition, shoulder joint, multipositional locking, flexion, adjustable abduction friction control, for use with body powered or external powered system ( L6646 )

• 24 Upper extremity addition, shoulder lock mechanism, body powered actuator ( L6647 )

• 25 Upper extremity addition, shoulder lock mechanism, external powered actuator ( L6648 )

• 26 Upper extremity addition, shoulder universal joint, each ( L6650 )

• 27 Upper extremity addition, standard control cable, extra ( L6655 )

• 28 Upper extremity addition, heavy duty control cable ( L6660 )

• 29 Upper extremity addition, Teflon, or equal, cable lining ( L6665 )

• 30 Upper extremity addition, hook to hand, cable adapter ( L6670 )

• 31 Upper extremity addition, harness, chest or shoulder, saddle type ( L6672 )

• 32 Upper extremity addition, harness, (e.g., figure of eight type), single cable design ( L6675 )

• 33 Upper extremity addition, harness, (e.g., figure of eight type), dual cable design ( L6676 )

• 34 Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow ( L6677 )

• 35 Upper extremity addition, test socket, wrist disarticulation or below elbow ( L6680 )

• 36 Upper extremity addition, test socket, elbow disarticulation or above elbow ( L6682 )

• 37 Upper extremity addition, test socket, shoulder disarticulation or interscapular thoracic ( L6684 )

• 38 Upper extremity addition, suction socket ( L6686 )

• 39 Upper extremity addition, frame type socket, below elbow or wrist disarticulation ( L6687 )

• 40 Upper extremity addition, frame type socket, above elbow or elbow disarticulation ( L6688 )

• 41 Upper extremity addition, frame type socket, shoulder disarticulation ( L6689 )

• 42 Upper extremity addition, frame type socket, interscapular-thoracic ( L6690 )

• 43 Upper extremity addition, removable insert, each ( L6691 )

• 44 Upper extremity addition, silicone gel insert or equal, each ( L6692 )

• 45 Upper extremity addition, locking elbow, forearm counterbalance ( L6693 )

• 46 Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism ( L6694 )

• 47 Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism ( L6695 )

• 48 Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code L6694 or L6695) ( L6696 )

• 49 Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code L6694 or L6695) ( L6697 )

• 50 Addition to upper extremity prosthesis, below elbow/above elbow, lock mechanism, excludes socket insert ( L6698 )