Summary & Overview
HCPCS Level II L6895: Upper-Extremity Prosthesis Glove, Custom Fabricated
HCPCS Level II code L6895 represents a custom-fabricated glove added to an upper-extremity prosthesis terminal device. This code captures a prosthetic accessory intended to improve fit, function, or cosmetic appearance for patients using terminal devices on upper-limb prostheses. Nationally, prosthetic accessory codes like L6895 matter because they affect access to customized components that can influence patient function and device utility.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what L6895 denotes, typical services and sites of care, and the practical billing context for custom-fabricated prosthetic gloves. The content outlines expected clinical context and common billing considerations rather than payer-specific coverage rules.
This publication provides benchmarks and policy-relevant context for clinicians, prosthetists, and billing professionals: how L6895 is classified, where the service is commonly delivered, and what stakeholders should consider when documenting the medical necessity and custom fabrication aspects. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code L6895 describes an addition to an upper extremity prosthesis consisting of a glove for a terminal device, made of any material and custom fabricated. This item is an accessory added to a prosthetic limb to provide a glove covering for the terminal device, tailored to the individual patient.
Service Type: Prosthetic accessory / custom fabrication
Typical Site of Service: Outpatient prosthetics clinic or prosthetic fabrication facility
Clinical & Coding Specifications
Clinical Context
A 45-year-old right-handed patient with a transradial amputation presents to a prosthetics clinic for fitting of an upper extremity prosthesis. The patient has a myoelectric terminal device and requires a custom-fabricated glove to improve cosmesis, grip interface, and protection of the terminal device. The workflow includes prosthetist evaluation, measurement and casting of the terminal device, fabrication of a custom glove (L6895) to match skin tone and fit over the terminal device, a fabrication lead time of 1–3 weeks, and a fitting/adjustment visit to verify fit and function. Documentation in the medical record includes the amputation level, functional goals, prior prosthetic history, detailed measurements or cast, materials used for the glove, and the date of delivery. Typical payors include commercial and government plans; billing is submitted with the prosthetic base code for the limb and the addition code L6895 as appropriate.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct procedural service | Not listed in the provided modifier set; Data not available in the input. |