L6360 Interscapular Thoracic | HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS L6360: Interscapular Thoracic Passive Restoration Prosthesis

HCPCS Level II code L6360 identifies a complete external prosthesis for interscapular thoracic passive restoration. The code covers devices intended to restore contour and provide passive structural support to the upper back (thoracic/interscapular) region following loss of tissue or structural integrity. Nationally, prosthetic device codes like L6360 matter for durable medical equipment management, prior authorization workflows, and consistency in coverage determinations across commercial and federal payers.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what L6360 represents clinically and operationally, typical sites of service where the prosthesis is supplied or fitted, and the payer landscape covered in the analysis. The publication provides benchmarking context, common billing practices, and relevant policy considerations for providers and billing staff managing claims for interscapular thoracic prostheses. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareL6360HCPCS Level IIprostheticsinterscapular thoracicdurable medical equipmentprosthesis codingbilling guidanceoutpatient prostheticsmedical device

Billing Code Overview

HCPCS Level II code L6360 describes an interscapular thoracic passive restoration complete prosthesis. This code represents a complete external prosthetic device designed to restore contour and support in the interscapular (upper back/thoracic) region using a passive restoration design.

Service type: Prosthetic device (external)

Typical site of service: Outpatient prosthetics clinic, durable medical equipment supplier, or ambulatory clinic

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 68-year-old male patient with a chronic interscapular thoracic soft-tissue defect after oncologic resection presents for placement of a complete passive prosthetic interscapular thoracic device (L6360) to restore contour and support tissue healing. The patient has stable cardiopulmonary status, medical clearance, and prior imaging confirming adequate soft-tissue envelope. The clinical workflow includes pre-procedure evaluation and measurements by a prosthetist and/or orthotist, documentation of functional and cosmetic goals, selection and fabrication of the complete prosthesis, a device-fitting visit with adjustments, instruction on skin care and device maintenance, and a follow-up visit to assess fit, skin integrity, and need for further modification. Typical sites of service are outpatient prosthetics/orthotics clinics, ambulatory surgery centers for fitting that requires complex shaping, or hospital outpatient departments when medical comorbidities require facility-level care. Common payors for authorization and reimbursement interactions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

Coding Specifications

Modifier	Description	When to Use
`11`	Primary procedure	When `L6360` is the principal service provided on the date of service

HCPCS L8040: Nasal Prosthesis Provided by Non-Physician

HCPCS-L5655-BELOW-KNEE-SOCKET-INSERT-PROSTHETIC-ADDITION

HCPCS L5655: Below-Knee Prosthetic Socket Insert

HCPCS-L5430-INITIAL-RIGID-DRESSING-AK-KNEE-DISARTICULATION

HCPCS L5430: Initial Rigid Dressing for AK or Knee Disarticulation

HCPCS-L6500-ABOVE-ELBOW-MOLDED-SOCKET-ENDOSKELETAL-PROSTHESIS

HCPCS L6500: Above-Elbow Molded Socket, Endoskeletal Prosthesis

HCPCS-L8513-TRACHEOESOPHAGEAL-VOICE-PROSTHESIS-CLEANING-DEVICE-REPLACEMENT

HCPCS L8513: Cleaning Device for Tracheoesophageal Voice Prosthesis, Replacement

HCPCS-L6050-WRIST-DISARTICULATION-MOLDED-SOCKET-FLEXIBLE-ELBOW-HINGES

HCPCS L6050: Wrist Disarticulation Molded Socket with Flexible Elbow Hinges

HCPCS-L6635-UPPER-EXTREMITY-ELBOW-LIFT-ASSIST

HCPCS L6635: Upper Extremity Addition, Elbow Lift-Assist

HCPCS-L5628-HEMIPELVECTOMY-TEST-SOCKET-ADDITION-LOWER-EXTREMITY

HCPCS L5628: Addition to Lower Extremity, Test Socket, Hemipelvectomy

HCPCS-L7403-UPPER-EXTREMITY-PROSTHESIS-ACRYLIC-ADDITION-BELOW-ELBOW

HCPCS L7403: Addition to Upper Extremity Prosthesis, Acrylic

HCPCS-L6611-UPPER-EXTREMITY-PROSTHESIS-EXTERNAL-POWERED-SWITCH

HCPCS L6611: Addition to Upper Extremity Prosthesis, External Powered Switch

Showing 1–10 of 472

Taxonomy Code	Specialty	Notes
`252S00000X`	Orthotics & Prosthetics	Primary specialty for device measurement, fabrication, and fitting
`2080P0200X`	Physical Medicine & Rehabilitation	Manages functional goals, therapy coordination, and prosthetic integration
`2084P0800X`	Orthopedic Surgery	Evaluates surgical sites, performs revisions, and coordinates prosthetic needs
`207L00000X`	Physical Therapist	Provides gait/posture training and device tolerance assessment
`163W00000X`	Wound Care Specialist	Manages skin integrity and pre/post-fitting wound care

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M75.81`	Other shoulder lesions, right shoulder	Soft-tissue scarring or contour defects that may extend interscapularly and require prosthetic contouring
`M75.82`	Other shoulder lesions, left shoulder	As above for left-sided involvement affecting thoracic/interscapular contour
`L90.5`	Scar conditions and fibrosis of skin	Scarring after surgery or trauma that produces contour defects addressed by a complete passive prosthesis
`T81.89XA`	Other complications of procedures, not elsewhere classified, initial encounter	Complications such as wound breakdown leading to need for prosthetic restoration of contour
`M89.9`	Bone disease, unspecified	Underlying thoracic wall deformity or resection that may necessitate a prosthetic device for contour restoration

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97760`	Orthotic management and training, initial encounter; fitting and training with basic prosthetic/orthotic device	Used for patient training and functional integration after placement of a passive thoracic prosthesis
`97763`	Orthotic/prosthetic management and training, subsequent encounters	Used for follow-up adjustments and training visits after initial fitting of `L6360`
`11970`	Implantation, dermal filler; 1 cc or more (for implantable soft-tissue filler when adjunctive contouring is required)	May be performed adjunctively for contour refinement in the interscapular region when small-volume implants are used with a prosthetic device
`11055`	Paring or cutting of benign hyperkeratotic lesion (e.g., callus); simple	Used when local skin care requires minor procedures related to prosthesis pressure areas
`99070`	Supplies and materials (except spectacles), used for direct care of the patient, not included in other codes, list separately in addition to code for primary service	Used to bill non-device supplies (dressings, adhesives) associated with prosthesis fitting and skin protection

OpenPayer