Summary & Overview
HCPCS L6130: Below-Elbow Molded Split Socket with Stump-Activated Hinge
HCPCS Level II code L6130 identifies a below-elbow, molded double wall split socket with a stump-activated locking hinge and half cuff used in upper-limb prosthetic care. This code represents a custom prosthetic socket component critical to upper-extremity rehabilitation, enabling secure suspension and mechanical control for activities of daily living. Nationally, L6130 is relevant to durable medical equipment management, prosthetics contracting, and clinical teams involved in limb loss care.
Key payers addressed in this publication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical purpose and typical site of service for this prosthetic component; benchmarks and coverage patterns where available; coding and billing considerations tied to device description; and references to related HCPCS items and service lines. The section on payer coverage summarizes which national payers commonly reimburse prosthetic sockets and highlights areas where policy variation is frequent. Where granular payer-specific benchmarks or related taxonomies are not provided in the input, the publication indicates that data is not available in the input and focuses on clinical and billing context. This summary serves clinicians, billing professionals, and policy analysts seeking a concise national-level briefing on HCPCS Level II code L6130.
Billing Code Overview
HCPCS Level II code L6130 describes a below elbow, molded double wall split socket with a stump activated locking hinge and half cuff. This device is a custom-molded prosthetic socket designed for patients with below-elbow limb loss; the stump-activated locking hinge allows the residual limb to engage or secure an attached prosthetic component.
Service type: Prosthetic socket fabrication and fitting
Typical site of service: Orthotics/prosthetics clinic or specialized prosthetic fabrication facility
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 45-year-old transtibial (below-elbow) amputee presents to a prosthetics clinic for fabrication of a custom below-elbow molded double-wall split socket with a stump-activated locking hinge and half cuff (L6130). The patient has a well-healed residual limb after traumatic amputation, adequate soft-tissue coverage, and wishes to regain distal grasp function using a body-powered or hybrid terminal device. The clinical workflow includes an initial prosthetic evaluation by a certified prosthetist, measurement and casting of the residual limb, socket design discussion (double-wall, split socket for improved suspension and comfort), selection and fitting of a stump-activated locking hinge and half cuff suspension, fabrication in the prosthetic lab, and multiple follow-up visits for alignment, trim modifications, pressure relief, and functional training. Device delivery is accompanied by gait/functional assessment, instruction on donning/doffing, skin care, and documentation of functional goals and outcomes.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no specific modifier applies to the claim for billing completeness |
11 |