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    v1.0.28
    OpenPayerBilling CodesProsthetic ProceduresHCPCS hcpcs-l6035-single-prosthetic-digit-mechanical
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    HCPCS Level II L6035: Single Mechanical Prosthetic Digit

    HCPCS Level II code L6035 describes a single mechanical prosthetic digit (finger) prosthesis that may include metacarpophalangeal (MCP), proximal interphalangeal (PIP), and/or distal interphalangeal (DIP) joint(s), with or without a locking mechanism and with possible flexion or extension assist; the service is provision of a single prosthetic digit device, typically supplied in an orthotics or prosthetics clinic or outpatient setting for patients requiring finger reconstruction or replacement, including initial issue or replacement.

    For related coverage guidance, see recent payer policy updates: Clinical Review Criteria — Lymphedema Therapy and Training (Complete Decongestive Therapy; LVA), Therapy Services — Electric Stimulation for Pain, Swelling and Function in a Clinic Setting, Site of Care: Outpatient Hospital Setting for Physical and Occupational Therapy.

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    Clinical & Coding Specifications

    Clinical Context

    A 45-year-old right-hand dominant carpenter presents to a prosthetics clinic following traumatic partial amputation of the index finger at the proximal phalanx. After initial wound healing and occupational therapy, the patient is evaluated for a single-digit prosthesis. The prosthetist assesses finger length, residual soft tissue, joint involvement, and activity demands. A mechanical single prosthetic digit (L6035) is selected to restore cosmesis and basic pinch/grasp. The workflow includes: pre-prosthetic assessment, measurements and molding, fabrication or ordering of the mechanical digit (initial issue or replacement), fitting and alignment, adjustment of any flexion/extension assist or locking mechanism, patient education on donning/doffing and care, and scheduled follow-up for adjustments and functional training. Typical documentation includes operative or injury history, limb status, functional goals, prosthetic selection rationale, measurements, device description (mcp/pip/dip joints; locking or assist features), date of issue, manufacturer/serial number, and plan for future repairs or replacement.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    Skill not providedData not available in the input.Data not available in the input.
    Skill not providedData not available in the input.Data not available in the input.
    Skill not providedData not available in the input.Data not available in the input.

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    P4Modifier P4 indicates the patient is ASA Physical Status IV — a patient with severe systemic disease that is a constant threat to life. It is assigned by the anesthesia provider and must be supported…- When to apply: Use modifier P4 only on anesthesia CPT codes (00100–01999) to indicate ASA Physical Status IV — a patient with severe systemic disease that is a constant threat to life (examples:…
    95Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207P00000XEmergency Medicine PhysicianAn emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospit…
    283Q00000XPsychiatric HospitalAn organization including a physical plant and personnel that provides multidisciplinary diagnostic and treatment mental health services to patients r…
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    207K00000XAllergy & Immunology PhysicianAn allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
    207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianA pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the labora…
    103TB0200XCognitive & Behavioral PsychologistA psychologist who reflects an experimental-clinical approach distinguished by use of principles of human learning and development and theories of cog…
    207RP1002XPhysician Nutrition Specialist (Internal Medicine)A physician who specializes in the diagnosis and treatment of primary nutritional diseases (e.g., undernutrition, overnutrition, and genetic or acquir…
    251X00000XSupports Brokerage AgencyA provider of service/function that assists participating individuals to make informed decisions about what will work best for them is consistent with…

    Related ICD-10-CM Codes

    9 rows

    ICD-10-CM CodeDescription
    M84.371AStress fracture, right ankle, initial encounter for fracture
    S68.111AComplete traumatic metacarpophalangeal amputation of left index finger, initial encounter
    S68.112AComplete traumatic metacarpophalangeal amputation of right middle finger, initial encounter
    S68.113AComplete traumatic metacarpophalangeal amputation of left middle finger, initial encounter
    S68.114AComplete traumatic metacarpophalangeal amputation of right ring finger, initial encounter
    S68.115AComplete traumatic metacarpophalangeal amputation of left ring finger, initial encounter
    S68.116AComplete traumatic metacarpophalangeal amputation of right little finger, initial encounter
    S68.119AComplete traumatic metacarpophalangeal amputation of unspecified finger, initial encounter
    Z89.611Acquired absence of right leg above knee

    Related Payer Policy Updates

    Specialty: Physical Medicine, Rehab & Therapies1 / 2

    3 rows

    PolicyPayerEffective Date
    Clinical Review Criteria — Lymphedema Therapy and Training (Complete Decongestive Therapy; LVA)Kaiser Permanente2026-09-01
    Therapy Services — Electric Stimulation for Pain, Swelling and Function in a Clinic SettingCigna2026-08-15
    Site of Care: Outpatient Hospital Setting for Physical and Occupational TherapyCigna2026-08-15

    Related Codes

    HCPCS-L5000-PARTIAL-FOOT-SHOE-INSERT-LONGITUDINAL-ARCH-TOE-FILLER

    HCPCS Level II L5000: Partial Foot Shoe Insert with Longitudinal Arch, Toe Filler

    HCPCS-L5010-PARTIAL-FOOT-MOLDED-SOCKET-ANKLE-HEIGHT-TOE-FILLER

    HCPCS L5010: Partial Foot Molded Socket, Ankle Height, With Toe Filler

    HCPCS-L5020-PARTIAL-FOOT-MOLDED-SOCKET-TIBIAL-TUBERCLE-TOE-FILLER

    HCPCS L5020: Partial Foot Molded Socket with Toe Filler

    HCPCS-L5050-ANKLE-SYMES-MOLDED-SOCKET-SACH-FOOT

    HCPCS L5050: Ankle/Symes Molded Socket with SACH Foot

    HCPCS-L5060-ANKLE-SYMES-METAL-FRAME-MOLDED-LEATHER-SOCKET-ARTICULATED-ANKLE-FOOT

    HCPCS L5060: Ankle/Symes Metal Frame with Molded Leather Socket

    HCPCS-L5100-BELOW-KNEE-MOLDED-SOCKET-SHIN-SACH-FOOT

    HCPCS Level II L5100: Below-Knee Molded Socket with Shin and SACH Foot

    HCPCS-L5105-BELOW-KNEE-PLASTIC-SOCKET-SACH-FOOT

    HCPCS L5105: Below-Knee Plastic Socket Prosthesis with SACH Foot

    HCPCS-L5150-KNEE-DISARTICULATION-MOLDED-SOCKET-EXTERNAL-KNEE-SACH-FOOT

    HCPCS L5150: Knee Disarticulation Molded Socket with External Knee and SACH Foot

    HCPCS-L5160-KNEE-DISARTICULATION-MOLDED-SOCKET-BENT-KNEE-SACH-FOOT

    HCPCS Level II L5160: Knee Disarticulation Molded Socket, Bent Knee Configuration

    HCPCS-L5200-ABOVE-KNEE-MOLDED-SOCKET-SINGLE-AXIS-KNEE-SACH-FOOT

    HCPCS Level II L5200: Above-knee Prosthesis with Molded Socket and Single-axis Knee

    Showing 1–10 of 472

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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