Article Detail - JA DME
Correct Billing for Upper Limb Prosthesis with L6895 instead of L7499
Revised May 18, 2012
Posted May 11, 2012
The Durable Medical Equipment Medicare Administrative Contractors (DME MACs), have discovered suppliers billing healthcare common procedure coding system, HCPCS L7499, [upper extremity prosthesis, not otherwise specified] for upper limb prosthetic cosmetic features such as; coloring, veins, hair, etc. Suppliers should be billing L6895 [addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated].
HCPCS 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 L7499 for the cost of the additional cosmetic features. The long narrative description for the L6895 indicates "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 the CMS' Alpha Numeric Workgroup. Located on the CMS web site: https://www.cms.gov/medicare/coding/medhcpcsgeninfo
