L6055 Wrist Disarticulation | HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS L6055: Wrist Disarticulation Prosthetic with Molded Socket and Elbow Hinges

HCPCS Level II code L6055 designates a custom upper-extremity prosthetic for wrist disarticulation that includes a molded socket with an expandable interface, flexible elbow hinges, and a triceps pad. The code captures a multi-component, patient-specific device used to restore function and support at the distal forearm and elbow after wrist-level amputation. Nationally, such prosthetic codes matter for access to rehabilitative technologies, durable medical equipment coverage decisions, and consistent billing practice across payers.

This analysis covers common national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for wrist-disarticulation prosthetics, typical sites of service, and the types of analyses tied to this code: coverage benchmarks, utilization considerations, and relevant billing practice notes. The summary flags when input data are not provided for specific items such as associated taxonomies, ICD-10 pairings, or related codes: Data not available in the input.

Healthcare administrators, prosthetists, and billing professionals will learn what this code represents, which payers are included in the review, and which topics (coverage scope, service setting, and device components) are central to adjudication and claim preparation for L6055.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareL6055HCPCS Level IIupper-extremity prosthesiswrist disarticulationprosthetic socketelbow hingesdurable medical equipmentprosthetics billingoutpatient prosthetics

Billing Code Overview

HCPCS Level II code L6055 describes a wrist disarticulation prosthetic with a molded socket and expandable interface, flexible elbow hinges, and a triceps pad. This device is a custom upper-limb prosthetic component designed for individuals with amputation through the wrist (wrist disarticulation) to provide a stable socket fit and elbow articulation support.

Service type: Upper-extremity prosthetic device (custom-molded socket with articulated elbow components).

Typical site of service: Prosthetics clinic or outpatient orthotics & prosthetics facility, where socket molding, fitting, and alignment of the elbow hinges and triceps pad are performed.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult who has undergone a wrist disarticulation (amputation through the radiocarpal joint) following traumatic injury, infection, or tumor. The prosthetic service described by L6055 — a molded socket with expandable interface, flexible elbow hinges, and a triceps pad — is delivered by a prosthetist in collaboration with an orthopedic surgeon and rehabilitation team. Workflow: initial surgical clearance and residual limb healing (usually 4–8 weeks), pre-prosthetic evaluation by a prosthetist including limb shape assessment and measurements, casting or digital scanning to create a molded socket with expandable interface, selection and fitting of flexible elbow hinges and triceps pad to optimize suspension and control, iterative fit adjustments during follow-up visits, physical and occupational therapy for donning/doffing, strengthening, and functional training, and final delivery with documentation of functional goals and outcome measures.

Coding Specifications

Modifier	Description	When to Use
`LT`	Left side (not in raw list)	Data not available in the input.
`RT`

HCPCS L8691: Auditory Osseointegrated External Sound Processor, Replacement Only

HCPCS-L5828-ENDOSKELETAL-KNEE-SHIN-SINGLE-AXIS-FLUID-CONTROL

HCPCS Level II L5828: Endoskeletal Knee-Shin Addition, Fluid Swing and Stance Control

HCPCS-L6682-UPPER-EXTREMITY-TEST-SOCKET-ELBOW-DISARTICULATION-ABOVE-ELBOW

HCPCS L6682: Upper Extremity Test Socket for Elbow Disarticulation or Above-Elbow

HCPCS-L6450-ELBOW-DISARTICULATION-MOLDED-ENDOSKELETAL-SOCKET

HCPCS L6450: Elbow Disarticulation Molded Endoskeletal Prosthetic Socket

HCPCS-L8681-NEUROSTIMULATOR-PATIENT-PROGRAMMER-REPLACEMENT

HCPCS L8681: Patient Programmer for Implantable Neurostimulator, Replacement Only

HCPCS-L8642-HALLUX-IMPLANT

HCPCS L8642: Hallux Implant

HCPCS-L7360-SIX-VOLT-BATTERY-DME-SUPPLY

HCPCS L7360: Six Volt Battery, DME Supply

HCPCS-L6645-SHOULDER-FLEXION-ABDUCTION-UPPER-EXTREMITY-ADDITION

HCPCS L6645: Upper Extremity Addition, Shoulder Flexion-Abduction Joint

HCPCS-L5712-EXOSKELETAL-SAFETY-KNEE-SINGLE-AXIS-FRICTION-CONTROL

HCPCS L5712: Exoskeletal Knee-Shin Addition, Single-Axis Safety Knee

HCPCS-L8035-CUSTOM-BREAST-PROSTHESIS-POST-MASTECTOMY

HCPCS L8035: Custom Breast Prosthesis, Post Mastectomy

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Taxonomy Code	Specialty	Notes
`207L00000X`	Orthopedic Surgery	Surgeons who perform amputations and surgical management of the residual limb.
`214000000X`	Prosthetics/Orthotics	Prosthetists who design, fabricate, and fit upper-limb prostheses.
`208000000X`	Physical Medicine & Rehabilitation	Physiatrists managing pre- and post-prosthetic rehabilitation and clearance.
`223Z00000X`	Occupational Therapy	Occupational therapists providing ADL training and functional prosthetic training.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S48.031A`	Complete traumatic amputation at wrist level, right wrist, initial encounter	Traumatic wrist disarticulation leading to need for a molded socket prosthesis.
`S48.032A`	Complete traumatic amputation at wrist level, left wrist, initial encounter	Traumatic left wrist disarticulation requiring prosthetic fitting.
`T87.89`	Complications of other specified procedures, not elsewhere classified	Postoperative complications affecting residual limb shape and prosthetic fitting.
`C79.89`	Secondary malignant neoplasm of other specified sites	Metastatic or primary tumor necessitating wrist disarticulation for oncologic control.
`L08.9`	Local infection of the skin and subcutaneous tissue, unspecified	Severe infection leading to amputation and subsequent prosthetic rehabilitation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97760`	Orthotic(s)/prosthetic(s) management and training, upper extremity, initial encounter	Use for patient training in donning, doffing, care, and functional use of the new prosthesis after delivery.
`97761`	Orthotic(s)/prosthetic(s) management and training, upper extremity, subsequent encounter	Use for follow-up training visits to advance functional skills with the prosthesis.
`99070`	Supplies and materials (e.g., tape, bandages), noncovered items, used during patient care	Use to bill non-implant supplies used during fitting and adjustments when payer permits.
`99456`	Work-related and medical disability examination services (impairment rating)	Use when an impairment rating or functional capacity evaluation is requested related to the amputation and prosthetic provision.
`20610`	Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., elbow)	Use occasionally when managing residual limb joint issues or bursitis that may impact socket fit (procedural adjunct).

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