Summary & Overview

HCPCS L6713: Pediatric Mechanical Voluntary-Opening Hand Terminal Device

HCPCS Level II code L6713 denotes a pediatric mechanical, voluntary-opening hand terminal device used as part of an upper-extremity prosthetic system. This code matters nationally because it standardizes billing for pediatric prosthetic terminal devices across suppliers and payers, supporting consistent coverage evaluation and reimbursement workflows for children requiring mechanical hand replacements.

Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for use in pediatric upper-extremity prosthetics, common sites of service, and the administrative classification for claims processing. The publication outlines typical billing considerations, common modifiers, and payer coverage patterns where available. It also summarizes policy and coding implications relevant to suppliers and clinicians working with pediatric prosthetic fittings and follow-up care.

The report provides benchmarks and policy notes that inform how payers treat durable medical equipment and prosthetic components, clarifies where L6713 fits within HCPCS Level II coding, and highlights operational points for billing and claims submission. Data not available in the input is identified explicitly in the relevant sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareL6713HCPCS Level IIpediatric prostheticsupper extremityterminal devicedurable medical equipmentprosthetic devicemechanical hand

Billing Code Overview

HCPCS Level II code L6713 describes a terminal device, hand, mechanical, voluntary opening, any material, any size, pediatric. This code represents a mechanical pediatric hand terminal device designed to open voluntarily under user control and provide an assistive replacement for a missing or nonfunctional hand.

Service type: Durable medical equipment/prosthetic terminal device for upper extremity prosthesis
Typical site of service: Durable medical equipment suppliers, outpatient prosthetics and orthotics clinics, pediatric rehabilitation centers, and home use

Clinical & Coding Specifications

Clinical Context

A pediatric patient with congenital upper limb deficiency or traumatic partial hand amputation is evaluated by a pediatric prosthetics team for functional restoration. The child is typically referred by a pediatric orthopedist, physiatrist, or occupational therapist after initial healing and assessment of residual limb anatomy. A certified prosthetist conducts a measurement and fitting visit to select an appropriately sized pediatric mechanical voluntary-opening terminal device. The device L6713 (terminal device, hand, mechanical, voluntary opening, any material, any size, pediatric) is ordered, fabricated or adjusted, and delivered during subsequent visits. Follow-up visits for alignment, harness adjustment, and occupational therapy training are scheduled to optimize grasp function and activity participation. Typical sites of service include outpatient prosthetics and orthotics clinics, pediatric rehabilitation centers, and hospital-based specialty clinics. Payors involved in coverage determinations often include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare for qualifying beneficiaries.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional component of a service related to prosthetic fitting by a licensed clinician when payor requires separation of professional and technical components.
`52`	Reduced services	Use when the prosthetic device or service is partially reduced in scope compared with standard practice.
`53`	Discontinued procedure	Use when fabrication or fitting is started but discontinued due to patient condition or other documented reason.
`54`	Surgical care only	Use if a surgeon provides only the surgical portion when a surgical procedure related to residual limb preparation is billed separately.
`55`	Postoperative management only	Use if only post-op prosthetic-related management is billed by a provider.
`62`	Two surgeons	Use when two surgeons of different specialties share responsibility for a surgical procedure related to limb salvage prior to prosthetic fitting.
`78`	Unplanned return to OR by same physician following initial procedure	Use if an unplanned reoperation occurs that affects subsequent prosthetic care.
`80`	Assistant surgeon	Use when an assistant surgeon is involved in a procedure that influences prosthetic provision.
`82`	Assistant surgeon (when qualified resident surgeon not available)	Use in similar situations where an assistant is required and no qualified resident is available.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for Medicare	Use when these clinicians furnish evaluation, fitting oversight, or adjustments and bill under Medicare rules.
`RR`	Rental equipment	Use when billing indicates the terminal device is provided on a rental basis rather than purchase.
`UE`	Left upper extremity	Use to indicate the device is for the left upper extremity when laterality is required by payor.
`RT`	Right side	Use to indicate the device is for the right upper extremity when laterality is required by payor.
`QX`	Ordering provider eligible for DMEPOS billing certificate; services furnished by an enrolled practitioner	Use when the ordering practitioner meets DMEPOS requirements and this affects supplier billing.

Taxonomy Code	Specialty	Notes
`207LP0000X`	Pediatric Orthopedics	Surgeons who evaluate congenital or traumatic limb deficiencies and coordinate prosthetic care.
`208100000X`	Physical Medicine & Rehabilitation	Physiatrists who manage functional rehabilitation and prosthetic prescription.
`334200000X`	Prosthetics & Orthotics	Certified prosthetists who measure, fabricate, fit, and adjust `L6713` devices.
`261QM0800X`	Occupational Therapy	Occupational therapists who provide training in functional use and activities of daily living.
`363LA2200X`	Pediatric Specialty	Pediatricians involved in care coordination and medical clearance for prosthetic fitting.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q71.3`	Congenital absence of hand	Common congenital indication for pediatric terminal devices to restore prehension and function.
`S48.011A`	Unspecified injury of right upper arm, initial encounter	Traumatic upper extremity injuries in children can lead to partial hand loss requiring a terminal device.
`S48.012A`	Unspecified injury of left upper arm, initial encounter	Same clinical relevance for left-sided traumatic injuries.
`S58.011A`	Traumatic amputation of right forearm, initial encounter	Traumatic partial or complete amputations necessitate prosthetic terminal devices for function.
`S58.012A`	Traumatic amputation of left forearm, initial encounter	Left-sided traumatic amputations with similar relevance.
`Z43.1`	Fitting and adjustment of other artificial limb	Used for encounters related to fitting and adjustment of pediatric terminal devices.
`D56.9`	Sickle-cell disease, unspecified	Included when vaso-occlusive complications lead to limb ischemia and surgical loss; less common but clinically plausible.
`M21.641`	Acquired deformity, right hand	Acquired deformities limiting hand function may be addressed with prosthetic terminal devices.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97760`	Orthotic(s) management and training, initial encounter, each 15 minutes; patient with upper extremity orthosis	Used for therapy sessions to train a pediatric patient in using a new voluntary-opening terminal device.
`97763`	Orthotic and prosthetic supply; training, initial encounter, each 15 minutes	Applied when the therapist provides prosthetic training specifically for the terminal device.
`97761`	Prosthetic training, upper and/or lower extremity, initial encounter, each 15 minutes	Used for direct prosthetic training focused on device use, donning/doffing, and functional tasks.
`99070`	Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or procedure	Used for billable small components or consumables provided at fitting that are not part of the device code.
`99499`	Unlisted evaluation and management service	Occasionally used for unique interdisciplinary care coordination not described by standard codes when payor requires an unlisted code for complex fittings.
`92507`	Treatment of speech, language, voice, communication, and/or auditory processing disorder; may be used when multidisciplinary team addresses communication-related prosthetic concerns	Used rarely in multidisciplinary clinics when communication technology interfaces with prosthetic devices.