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    v1.0.28
    OpenPayerBilling CodesProsthetic ProceduresHCPCS hcpcs-l6036-prosthetic-mechanical-thumb
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    HCPCS Level II L6036: Mechanical Prosthetic Thumb

    HCPCS Level II code L6036 describes a mechanical prosthetic thumb (initial issue or replacement) that may include metacarpophalangeal and interphalangeal joint components, optional locking mechanism, and flexion or extension assist; service type is a prosthetic upper extremity device typically provided in prosthetics/orthotics clinics, outpatient rehabilitation centers, or specialized prosthetic fabrication facilities for patients requiring thumb reconstruction 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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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 34-year-old right-hand–dominant construction worker presents after a traumatic avulsion injury to the dominant thumb resulting in loss of the distal phalanx and instability of the carpometacarpal and metacarpophalangeal regions. Following assessment by hand surgery and occupational therapy, the patient is scheduled for provision of a mechanical prosthetic thumb to restore pinch and gross grasp. The clinical workflow includes pre-prosthetic assessment (wound healing, residual limb shaping, range-of-motion and strength testing), fitting and fabrication of a custom or prefabricated mechanical prosthetic thumb (L6036) with possible locking or flexion-assist mechanisms, initial adjustments in the clinic, patient education on donning/doffing and care, and follow-up visits for alignment, component replacement, and functional training with hand therapy.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    97530Therapeutic activities, direct (one-on-one) patient contact by the provider; each 15 minutesOccupational therapy sessions for functional training with the prosthetic thumb following fitting.
    97035Ultrasound therapy, each 15 minutesAdjunctive modality sometimes used in pre-prosthetic or post-injury rehabilitation for soft tissue healing prior to fitting.
    99070Supplies and materials provided by the physician over and above those usually included with the office visitUse for ancillary disposable supplies or custom materials used in the fitting session not included in the prosthesis allowance.
    99456Work-related or medical disability examination services (for initial workplace disability evaluations)Used when functional capacity or work restrictions are assessed in the context of returning to manual occupations after thumb prosthesis fitting.
    20610Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., may be used for diagnostic/therapeutic injections)Occasionally performed prior to definitive prosthetic planning when joint injections are part of pain management in the residual limb.

    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…
    74Modifier ‑74 indicates an outpatient hospital or ASC procedure that was discontinued after anesthesia was administered and after the procedure had begun. Use this modifier when anesthesia (local,…- Use modifier -74 when a procedure in an outpatient hospital or ASC setting is terminated after anesthesia has been administered and after the procedure has commenced (for example, after incision,…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    2084P0800XPsychiatry PhysicianA Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
    207X00000XOrthopaedic Surgery PhysicianAn orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated…
    207K00000XAllergy & Immunology PhysicianAn allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
    207ZP0007XMolecular Genetic Pathology (Pathology) PhysicianA molecular genetic pathologist is expert in the principles, theory and technologies of molecular biology and molecular genetics. This expertise is us…
    152WL0500XLow Vision Rehabilitation OptometristOptometrists who specialize in low-vision care having training to assess visual function, prescribe low-vision devices, develop treatment plans, and r…
    207XS0117XOrthopaedic Surgery of the Spine PhysicianRecognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic surgeons of the spine deal with th…
    251F00000XHome Infusion AgencyAgencies · Home Infusion
    103TP2701XGroup Psychotherapy PsychologistA psychologist who specializes in group psychology and group psychotherapy that is an evidenced-based specialty that prepares group leaders to identif…

    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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