Browse HCPCS Level II 2020 Edition

HCPCS Level II Table of Contents

L6703 - L6882  Prosthetic Procedures - Terminal Devices

L6703
Terminal device, passive hand/mitt, any material, any size
shortTerm dev, passive hand mitt
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L6704
Terminal device, sport/recreational/work attachment, any material, any size
shortTerm dev, sport/rec/work att
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L6706
Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined
shortTerm dev mech hook vol open
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L6707
Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined
shortTerm dev mech hook vol close
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L6708
Terminal device, hand, mechanical, voluntary opening, any material, any size
shortTerm dev mech hand vol open
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L6709
Terminal device, hand, mechanical, voluntary closing, any material, any size
shortTerm dev mech hand vol close
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L6711
Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined, pediatric
shortPed term dev, hook, vol open
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L6712
Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined, pediatric
shortPed term dev, hook, vol clos
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L6713
Terminal device, hand, mechanical, voluntary opening, any material, any size, pediatric
shortPed term dev, hand, vol open
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L6714
Terminal device, hand, mechanical, voluntary closing, any material, any size, pediatric
shortPed term dev, hand, vol clos
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L6715
Terminal device, multiple articulating digit, includes motor(s), initial issue or replacement
shortTerm device, multi art digit
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH5.03 Date of Service Edit: ClinicalAnatomic Consideration
DME5.03 Date of Service Edit: ClinicalAnatomic Consideration
L6721
Terminal device, hook or hand, heavy duty, mechanical, voluntary opening, any material, any size, lined or unlined
shortHook/hand, hvy dty, vol open
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L6722
Terminal device, hook or hand, heavy duty, mechanical, voluntary closing, any material, any size, lined or unlined
shortHook/hand, hvy dty, vol clos
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L6805
Addition to terminal device, modifier wrist unit
shortTerm dev modifier wrist unit
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L6810
Addition to terminal device, precision pinch device
shortTerm dev precision pinch dev
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.03 Date of Service Edit: ClinicalAnatomic Consideration
DME2.03 Date of Service Edit: ClinicalAnatomic Consideration
L6880
Electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s)
shortElec hand ind art digits
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L6881
Automatic grasp feature, addition to upper limb electric prosthetic terminal device
shortTerm dev auto grasp feature
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L6882
Microprocessor control feature, addition to upper limb prosthetic terminal device
shortMicroprocessor control uplmb
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration