L6028 Partial Hand Prosthesis HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS L6028: Partial Hand/Finger/Thumb Prosthesis, Metacarpal Level

HCPCS Level II code L6028 covers fabrication and fitting of a partial hand, finger, and thumb prosthesis for amputation at the metacarpal level, providing a molded, non-powered interface and optional passive prosthetic digit or thumb. This code captures a common category of upper-extremity prosthetic care that supports functional restoration after partial hand amputations and is relevant across payer types given its role in rehabilitative and durable medical equipment services.

Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of coding intent and clinical context, typical sites of service, common modifiers used with the code, and related billing considerations. The publication also summarizes what stakeholders need to know about billing scope—what the code includes and excludes—and highlights areas where policy clarification or documentation can affect coverage decisions.

The content is aimed at clinicians, billing specialists, and policy analysts seeking clear, national-level guidance on classification and clinical use of L6028. Data not available in the input is noted where applicable; the focus remains on code definition, service context, and payer coverage scope rather than specific state policies or detailed reimbursement rates.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareL6028HCPCS Level IIprosthesisupper extremitypartial handprosthetic devicedurable medical equipmentrehabilitationoutpatient prosthetics

Billing Code Overview

HCPCS Level II code L6028 describes a partial hand, finger, and thumb prosthesis without prosthetic digit(s)/thumb for patients with amputation at the metacarpal level. The device is molded to the patient model, includes a flexible or non-flexible interface, and is intended for use without external power and/or as a passive prosthetic digit/thumb. The description specifies that the code does not include inserts described by L6692.

Service type: Prosthetic fitting and fabrication of a partial upper-extremity (hand/finger/thumb) prosthesis
Typical site of service: Prosthetics and orthotics clinic, outpatient rehabilitation facility, or specialty prosthetics provider setting

Clinical & Coding Specifications

Clinical Context

A 45-year-old patient presents to a prosthetics clinic after a traumatic amputation of the index and middle fingers through the metacarpal level of the dominant right hand. The residual limb has healed, soft-tissue volume is stable, and the patient reports difficulty performing activities of daily living such as grasping a cup, typing, and personal hygiene. The certified prosthetist conducts a comprehensive evaluation including residual limb inspection, range of motion of the wrist and remaining digits, functional needs assessment, and occupational goals. A custom-molded partial hand prosthesis without powered digits is recommended to restore hand contour and passive prehension. The workflow includes: pre-prosthetic assessment and measurements; creation of a patient model (casting or digital scan); fabrication of a flexible or rigid interface socket molded to the model; fitting of the passive prosthetic digits/thumb; iterative adjustments and alignment; training and hand therapy sessions with an occupational therapist for donning/doffing, skin care, and task-specific practice; and final delivery with documentation of functional outcomes. Typical site of service is an outpatient prosthetics/orthotics clinic or an ambulatory surgery/prosthetics center when fabrication and fitting require specialized equipment.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the fabrication or fitting required substantially greater work or complexity than usual, documented in the record.

HCPCS L8684: External Radiofrequency Transmitter for Sacral Neurostimulator Replacement

HCPCS-L5930-HIGH-ACTIVITY-KNEE-CONTROL-FRAME

HCPCS L5930: Addition to Endoskeletal System, High Activity Knee Control Frame

HCPCS-L8688-IMPLANTABLE-NEUROSTIMULATOR-PULSE-GENERATOR-DUAL-ARRAY-NON-RECHARGEABLE

HCPCS L8688: Implantable Neurostimulator Pulse Generator, Dual Array, Non-Rechargeable

HCPCS-L6693-UPPER-EXTREMITY-LOCKING-ELBOW-FOREARM-COUNTERBALANCE

HCPCS L6693: Upper Extremity Addition, Locking Elbow with Forearm Counterbalance

HCPCS-L6036-PROSTHETIC-MECHANICAL-THUMB

HCPCS L6036: Mechanical Prosthetic Thumb, Initial Issue or Replacement

HCPCS-L8685-IMPLANTABLE-RECHARGEABLE-NEUROSTIMULATOR-PULSE-GENERATOR

HCPCS L8685: Implantable Rechargeable Neurostimulator Pulse Generator

HCPCS-L5985-ENDOSKELETAL-LOWER-EXTREMITY-DYNAMIC-PYLON

HCPCS L5985: Endoskeletal Lower Extremity Prosthesis, Dynamic Pylon

HCPCS-L6960-SHOULDER-DISARTICULATION-EXTERNAL-POWER-PROSTHESIS

HCPCS L6960: Shoulder Disarticulation External Power Prosthesis

HCPCS-L5657-LOWER-EXTREMITY-ADJUSTABLE-SOCKET-INSERT-LIMB-VOLUME-MANAGEMENT

HCPCS L5657: Lower-Extremity Adjustable Socket Insert for Limb Volume Management

HCPCS-L5520-PREPARATORY-BELOW-KNEE-PTB-SOCKET-PYLON-SACH-FOOT

HCPCS L5520: Preparatory Below-Knee PTB Socket with Pylon and SACH Foot

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Taxonomy Code	Specialty	Notes
`331K00000X`	Prosthetics and Orthotics	Certified prosthetist/orthotist who designs and fits partial hand prostheses.
`244Z00000X`	Occupational Therapy	Occupational therapist provides training for activities of daily living and device integration.
`207L00000X`	Hand Surgery	Orthopedic or plastic surgeon specializing in hand surgery who manages amputation and surgical follow-up.
`102W00000X`	Physical Therapy	Physical therapist involved in edema control, range-of-motion, and strengthening pre/post fitting.
`311N00000X`	Durable Medical Equipment Supplier	Supplier taxonomy for billing and coordination of prosthetic fabrication and delivery.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S68.121A`	Partial amputation of right index finger at metacarpal level, initial encounter	Common traumatic indication for a partial hand prosthesis replacing missing digits at the metacarpal level.
`S68.122A`	Partial amputation of left index finger at metacarpal level, initial encounter	Same as above for the left hand; lateralization matters for billing and documentation.
`S68.221A`	Partial amputation of right middle finger at metacarpal level, initial encounter	Indicates loss of middle finger structures that prosthesis aims to restore passively.
`S68.222A`	Partial amputation of left middle finger at metacarpal level, initial encounter	As above for the left middle finger.
`T87.89`	Other complications of amputation and residual limb	Used when there are complications (e.g., poor fit, skin breakdown) that affect prosthetic fitting and follow-up.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97760`	Orthotic (prosthetic) management and training, initial encounter, each 15 minutes	Used for training the patient in donning/doffing, skin care, and functional use of the partial hand prosthesis during initial occupational therapy sessions.
`97763`	Orthotic/prosthetic management and training, subsequent encounter, each 15 minutes	Used for follow-up therapy visits focused on device use and activity progression after initial fitting.
`99070`	Supplies and materials (noncovered items) used by physician or other qualified health care professional	Used to bill small adjunctive materials (skin liners, adhesives, padding) provided during fitting when not included in prosthesis fee and allowed by payer.
`99072`	Additional supplies, materials, and clinical staff time over and above those usually included	Use for enhanced infection control or additional PPE/time required during fitting sessions when payer permits.
`21010`	Reconstruction, mandible or maxilla — Note: Data not applicable for hand; included only when related head/neck reconstruction is relevant	Data not applicable in typical hand prosthesis workflow; no routine hand CPT equivalents provided in the input.

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