HCPCS L6300: Shoulder Disarticulation Prosthetic Assembly, Molded Socket - OpenPayer

Summary & Overview

HCPCS L6300: Shoulder Disarticulation Prosthetic Assembly, Molded Socket

HCPCS Level II code L6300 specifies a custom shoulder‑level (shoulder disarticulation) prosthetic assembly that includes a molded socket, shoulder bulkhead, humeral section, internal locking elbow, and forearm. This code captures complex upper‑extremity prostheses that restore function for patients with shoulder disarticulation and is important for national durable medical equipment (DME) and prosthetics billing because of its high-cost, specialized fabrication and fitting requirements.

Key payers in the national market include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for shoulder‑level prostheses, typical sites of service (prosthetics/orthotics clinics and DME providers), and the kinds of benchmarks and policy considerations that influence coverage and payment for custom prosthetic assemblies. The publication summarizes payer coverage patterns, common billing modifiers used with this HCPCS Level II code, and policy updates or documentation expectations relevant to claims processing and medical necessity determinations.

The content is designed for clinicians, billing professionals, prosthetists, and policy analysts seeking concise guidance on the clinical role and billing context of L6300, including what to expect in documentation, typical service workflows, and where to find payer policy details. Data not available in the input will be identified explicitly in the relevant sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareL6300HCPCS Level IIupper extremity prosthesisshoulder disarticulationprostheticsdurable medical equipmentdevice fabricationprosthetic fitting

Billing Code Overview

HCPCS Level II code L6300 describes a shoulder disarticulation prosthetic socket assembly that includes a molded socket, shoulder bulkhead, humeral section, internal locking elbow, and forearm. This code represents a custom upper‑extremity prosthesis component designed for patients with shoulder disarticulation (shoulder-level) amputation.

Service type: Custom prosthetic device fabrication and assembly for upper‑extremity shoulder disarticulation
Typical site of service: Prosthetics/orthotics clinic or specialty durable medical equipment provider with fabrication facilities

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult who underwent a traumatic proximal upper‑extremity amputation at the shoulder level or requires elective shoulder disarticulation for malignant disease or severe infection. The patient presents to a multidisciplinary prosthetics clinic after surgical amputation and wound healing. The clinical workflow includes prosthetist evaluation, measurement and casting for a custom molded shoulder socket with shoulder bulkhead and humeral section, fitting of an internal locking elbow mechanism, and forearm component integration. Initial appointments involve functional assessment, residual limb shaping and shrinker use, detailed casting or digital scanning, fabrication of the molded socket and internal locking elbow, and a delivery visit for alignment, training, and adjustments. Follow-up visits address pressure areas, prosthetic suspension, component function, and gait/activities training with occupational therapy. Typical site of service is an outpatient prosthetics and orthotics clinic or specialty prosthetics center; fabrication occurs in a certified prosthetic lab and fittings may occur in outpatient hospital-based clinics when complex medical comorbidity exists.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the prosthetist’s professional fitting/evaluation component if separated from fabrication charges billed by a supplier.

HCPCS L5783: Adjustable Lower-Extremity Residual Limb Volume Management System

HCPCS-L6698-UPPER-EXTREMITY-PROSTHESIS-LOCK-MECHANISM

HCPCS L6698: Upper Extremity Prosthesis Addition, Lock Mechanism

HCPCS-L6580-PREPARATORY-BELOW-ELBOW-PLASTIC-SOCKET-FRICTION-WRIST

HCPCS L6580: Preparatory Below-Elbow Plastic Socket, Friction Wrist

HCPCS-L5988-LOWER-LIMB-PROSTHESIS-SHOCK-REDUCING-PYLON

HCPCS L5988: Lower Limb Prosthesis Vertical Shock-Reducing Pylon

HCPCS-L6028-PARTIAL-HAND-FINGER-THUMB-PROSTHESIS-METACARPAL-LEVEL

HCPCS L6028: Partial Hand/Finger/Thumb Prosthesis, Metacarpal Level

HCPCS-L7009-ELECTRIC-MYOELECTRIC-HOOK-ADULT

HCPCS L7009: Electric/Myoelectric Adult Prosthetic Hook

HCPCS-L8042-ORBITAL-PROSTHESIS-NON-PHYSICIAN

HCPCS L8042: Orbital Prosthesis Provided by Non-Physician

HCPCS-L5649-LOWER-EXTREMITY-ISCHIAL-CONTAINMENT-NARROW-ML-SOCKET

HCPCS L5649: Addition to Lower Extremity Ischial Containment/Narrow M-L Socket

HCPCS-L5855-HIP-DISARTICULATION-ENDOSKELETAL-HIP-EXTENSION-ASSIST

HCPCS L5855: Endoskeletal Hip Prosthesis Addition, Mechanical Extension Assist

HCPCS-L7260-ELECTRONIC-WRIST-ROTATOR

HCPCS L7260: Electronic Wrist Rotator (Otto Bock or Equal)

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Taxonomy Code	Specialty	Notes
`173G00000X`	Prosthetics & Orthotics	Primary specialty for custom upper‑extremity prosthesis fabrication and fitting.
`207LA0500X`	Orthopedic Surgery	Orthopedic surgeons are frequently involved in preprosthetic surgical care and complex revisions.
`231H00000X`	Occupational Therapy	OT provides functional training, ADL training and prosthetic use rehabilitation.
`103T00000X`	Physical Therapy	PT assists with strength, endurance, and mobility training for shoulder‑level amputees.
`103K00000X`	Physician Assistant	PAs may perform evaluations and follow‑up in prosthetics clinics under supervising physician arrangements.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S48.011A`	Traumatic amputation of right shoulder, initial encounter	Direct traumatic cause leading to shoulder disarticulation and need for a molded shoulder socket prosthesis.
`S48.012A`	Traumatic amputation of left shoulder, initial encounter	Contralateral traumatic shoulder amputation requiring custom shoulder prosthesis.
`C41.9`	Malignant neoplasm of bone and articular cartilage, unspecified site	Proximal malignant tumor necessitating surgical resection at shoulder level and subsequent prosthetic rehabilitation.
`T87.89`	Other complications of surgical and medical care, not elsewhere classified	Postoperative complications or wound issues that may influence timing and design of prosthetic fitting.
`L89.309`	Pressure ulcer of unspecified shoulder, stage 3	Residual limb skin breakdown affecting socket design, suspension, and need for pressure‑relief modifications.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97760`	Orthotic management and training, initial encounter, lower or upper extremity, with fitting and adjustment of a custom fabricated or custom fitted orthosis; first orthosis	Used for training and initial fitting sessions when delivering a complex custom shoulder prosthesis and teaching donning/doffing and functional use.
`97763`	Orthotic / prosthetic training, myoelectric controls, upper and lower extremity, each 15 minutes	Used when the prosthesis incorporates myoelectric or electronic elbow/terminal device controls requiring specialized training.
`99070`	Supplies and materials provided by the physician over and above those usually included with the office visit or other services (eg, wound care supplies)	Used to bill separately for expendable supplies used during fitting or adjustments when payer allows.
`99080`	Prolonged service (e.g., more than typical) or administration for special documentation requirements	Used for time‑intensive evaluation/fitting encounters requiring extended documentation beyond typical visit allowances.
`11981`	Insertion, removal and replacement of implantable neurostimulator pulse generator or receiver, direct or inductive coupling (includes connection)	Data not available in the input.

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