Summary & Overview
HCPCS L6890: Prefabricated Glove for Upper Extremity Prosthesis
HCPCS Level II code L6890 denotes a prefabricated glove added to an upper extremity prosthesis, including fitting and adjustment. The code captures a common prosthetic accessory used to cover or enhance a terminal device for upper limb prostheses. Nationally, this code is relevant to prosthetics suppliers, outpatient clinics, and payers managing durable medical equipment and orthotics/prosthetics benefits.
Key payers in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what the code represents, the clinical and service context for use, and coverage considerations typically encountered across major commercial and public payers. The publication summarizes billing and coding implications, common modifier usage patterns (listed separately), and typical sites of service where L6890 is applied.
This analysis provides benchmarks for utilization and common policy themes affecting coverage decisions, highlights documentation elements associated with prosthetic additions and fittings, and outlines where to find further payer-specific policy language. Data not available in the input is noted where applicable; the focus remains on the clinical description, service context, and payer coverage landscape for HCPCS Level II code L6890.
Billing Code Overview
HCPCS Level II code L6890 describes an addition to an upper extremity prosthesis consisting of a glove for a terminal device, fabricated from any material, prefabricated, and including fitting and adjustment. This item is an ancillary component added to an existing upper limb prosthetic device to provide a cosmetic or functional covering for the terminal device.
Service type: Prosthetic accessory/service for upper extremity prosthesis
Typical site of service: Prosthetics/patient-based fitting setting, such as prosthetics clinics, outpatient prosthetic service locations, or other clinical settings where prosthetic fittings and adjustments are performed.
Clinical & Coding Specifications
Clinical Context
A 45-year-old right-handed male with a transradial amputation presents to an outpatient prosthetics clinic for prosthesis optimization. The patient has a myoelectric terminal device but reports poor seal and limited dexterity due to wear of the prefabricated glove covering the terminal device. The prosthetist evaluates the prosthesis in the clinic, documents the need for a replacement prefabricated glove for the terminal device, and completes fitting and adjustment to ensure proper fit, suspension, and functional range of motion. The workflow includes device inspection, selection of L6890 as the addition to the upper extremity prosthesis, fabrication or ordering of the prefabricated glove, in-clinic fitting, adjustments to alignment and suspension, functional testing, and documentation of patient tolerance and outcome. Typical site of service is an outpatient prosthetics/orthotics clinic or rehabilitation clinic; services may also occur in an ambulatory surgery center only if concurrent procedures require that setting. The patient scenario commonly involves established prosthesis users needing routine maintenance or replacement of a prefabricated glove for the terminal device to restore function and comfort.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when the glove addition is for the left upper extremity prosthesis |