Summary & Overview
HCPCS L6320: Shoulder Disarticulation Shoulder Cap, Passive Restoration
HCPCS Level II code L6320 identifies a prosthetic component: shoulder disarticulation passive restoration (shoulder cap only). This code documents supply of a prosthetic shoulder cap used to restore contour and facilitate prosthesis fit following surgical shoulder disarticulation. Nationally, accurate coding for this specialized prosthetic component supports appropriate claims processing, device provision, and care coordination for upper-limb amputees.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code's clinical context, how it maps to service lines and typical sites of service, and what to expect in payer coverage and billing practice. The publication summarizes common modifiers and payer considerations where available, presents benchmarking and reimbursement context when present, and highlights policy or coding guidance relevant to prosthetic device components.
This resource is intended for billing professionals, prosthetists, clinical managers, and policy analysts seeking a focused reference on L6320 for national billing and coverage considerations. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code L6320 describes shoulder disarticulation, passive restoration (shoulder cap only). The service is a prosthetic/orthotic passive restoration component designed to restore the shoulder contour after shoulder disarticulation. The service type is prosthetic/orthotic device component, and the typical site of service is outpatient prosthetics/orthotics clinic or durable medical equipment provider setting.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 55-year-old patient presents after a traumatic high-energy injury to the upper extremity resulting in non-salvageable distal humeral and shoulder girdle structures. The patient underwent surgical shoulder disarticulation (through the glenohumeral joint) with placement of a passive shoulder cap prosthetic component to restore shoulder contour and allow suspension of a prosthetic limb. The clinical workflow includes preoperative evaluation by orthopedic and prosthetics teams, intraoperative documentation of disarticulation level and tissues preserved, immediate postoperative wound care and pain management, and timely prosthetist fitting for the L6320 shoulder cap (passive restoration) once incision healing is adequate. Postoperative visits document wound healing, prosthetic socket fit, and functional training with occupational therapy. Encounters occur in a hospital operating room for the amputation and in outpatient prosthetics clinics for the L6320 device fitting and adjustments.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no modifier is required for the claim |