Summary & Overview
HCPCS L6350: Interscapular Thoracic Upper-Extremity Prosthetic Socket
HCPCS Level II code L6350 identifies a complex, custom-fabricated interscapular thoracic prosthetic socket with a molded socket, shoulder bulkhead, humeral section, internal locking elbow, and forearm. This code captures a high-acuity upper-extremity prosthesis intended to restore shoulder and distal limb function for patients with extensive transhumeral or higher-level limb loss. Nationally, such devices are significant for durable medical equipment (DME) and prosthetics spending and for coordinating multidisciplinary prosthetic care.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and typical sites of service, programmatic considerations for coverage and coding, and what types of benchmarks and utilization patterns are typically relevant for this category of prosthetic devices. The publication provides national-level context on billing practice for advanced upper-extremity prostheses, common procedural and documentation elements linked to prosthetic fabrication and fitting, and policy or reimbursement factors that influence access to custom prosthetic sockets.
Data not available in the input for associated taxonomies, specific ICD-10 pairings, related codes, and service-line financial benchmarks.
Billing Code Overview
HCPCS Level II code L6350 describes an interscapular thoracic prosthetic socket with a molded socket, shoulder bulkhead, humeral section, internal locking elbow, and forearm component. This device is a custom-fabricated upper-extremity prosthesis designed to provide shoulder and humeral support with an integrated internal locking elbow and forearm section for functional arm replacement.
Service Type: Prosthetic upper-extremity device fabrication and fitting
Typical Site of Service: Outpatient prosthetics clinic or orthotics and prosthetics facility
Clinical & Coding Specifications
Clinical Context
A 58-year-old right-hand-dominant male with a transhumeral amputation and high-level shoulder girdle scarring presents to a prosthetics clinic for fitting of an interscapular thoracic prosthesis. The device described by billing code L6350 is a molded socket with a shoulder bulkhead and humeral section, internal locking elbow, and forearm. Typical workflow: initial evaluation by a prosthetist and physiatrist to review amputation level, residual limb shape, and shoulder/torso mobility; measurements and casting for a molded interscapular-thoracic socket; fabrication of the shoulder bulkhead and humeral section in the prosthetic lab; selection and fitting of an internal locking elbow and a compatible forearm component; bench alignment and dynamic fitting session in clinic to assess suspension, range of motion, and comfort; training with an occupational therapist for donning/doffing, care, and functional use; follow-up visits for adjustments and potential socket modifications. Typical site of service is an outpatient prosthetics clinic or specialized orthotics and prosthetics facility; pre-fitting assessments or surgical consultation may occur in an outpatient rehabilitation or physiatry clinic. Common patient goals include improved prosthetic suspension, control of a humeral prosthesis with a secure shoulder interface, and restoration of activities of daily living such as grooming, feeding, and light household tasks. Payors encountered in authorization and billing workflows commonly include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
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