Summary & Overview
HCPCS L6200: Elbow Disarticulation Molded Socket with Outside Locking Hinge, Forearm
HCPCS Level II code L6200 represents fabrication and fitting of an elbow disarticulation molded socket with an outside locking hinge for the forearm. This code covers a specialized prosthetic component used when the elbow joint is disarticulated, providing an external locking hinge to support forearm function. The code is nationally relevant because prosthetic device configuration and coverage affect functional outcomes, device selection, and durable medical equipment policy across payers.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of typical coverage and billing considerations, national benchmarking context where available, clinical context for when an elbow-disarticulation molded socket with outside locking hinge is used, and common payer behaviors to expect. The publication summarizes what clinicians and billing professionals need to know about claims coding for this prosthetic socket type, common procedural contexts for fitting and adjustment in outpatient prosthetics clinics or rehabilitation settings, and areas where data was not provided.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and detailed payer-specific coverage rules. The report highlights themes relevant to prosthetics procurement, billing consistency, and clinical-fit considerations for providers and administrative teams working with L6200.
Billing Code Overview
HCPCS Level II code L6200 describes an elbow disarticulation prosthetic socket with an outside locking hinge for the forearm. The service is a prosthetic device fabrication and fitting for patients requiring an elbow-disarticulation style socket and integrated outside locking hinge mechanism. The typical site of service is prosthetics/orthotics clinic or outpatient rehabilitation setting, where clinicians measure, mold, fit, and adjust the prosthetic socket for functional forearm use.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 45-year-old patient presents after a traumatic high-energy crush injury to the distal humerus and forearm resulting in severe soft-tissue loss, uncontrolled infection, and nonreconstructable neurovascular damage. Following multidisciplinary evaluation, the orthopedic and prosthetics teams determine that an elbow disarticulation with a custom-molded socket and an outside locking hinge at the forearm level is indicated for definitive limb management and prosthetic rehabilitation. The clinical workflow includes preoperative surgical evaluation and clearance, coordination with a prosthetist to capture limb measurements and cast the residual limb, intraoperative elbow disarticulation performed by an orthopedic surgeon, postoperative wound care and pain management, suture removal and stump maturation, fabrication and fitting of the custom-molded socket incorporating an outside locking hinge, prosthetic training with occupational therapy, and routine follow-up for device adjustments and functional assessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier - standard reporting | Use for routine, complete billing when no special circumstance applies |
11 | Primary surgeon |