L6915 Hand Restoration (HCPCS) Reimbursement | OpenPayer

Summary & Overview

HCPCS L6915: Hand Restoration and Replacement Glove

HCPCS Level II code L6915 represents hand restoration services including shading and measurements, and the replacement glove associated with the prosthetic restoration. This code captures a specialized prosthetic/orthotic service that supports cosmetic restoration and proper fit for upper-extremity prostheses. Nationally, such services affect coverage determinations, prosthetic supply chains, and patient access to functional and cosmetic limb solutions.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coverage considerations across these payers, typical sites of service, and the clinical context surrounding prosthetic hand restoration. The report outlines benchmarking topics relevant to utilization and reimbursement for prosthetic replacement components and related restoration services.

This publication provides clinicians, billing staff, and policy analysts with concise context on the code's clinical purpose, typical care settings, and payer landscape. It also highlights where data are available for benchmarking and where input is not provided. Data not available in the input.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareL6915HCPCS Level IIprostheticsorthoticshand restorationreplacement glovedurable medical equipmentoutpatient clinic

Billing Code Overview

HCPCS Level II code L6915 describes hand restoration (shading, and measurements included), replacement glove for above. The service type is prosthetic/orthotic hand restoration and replacement glove fabrication, focused on restoring cosmetic appearance and fit for a prosthetic hand. The typical site of service is an outpatient prosthetics/orthotics clinic or specialty durable medical equipment facility.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient with a history of thermal burn and partial-thickness hand contracture presents to a prosthetics and orthotics clinic for evaluation of a custom silicone restoration glove. The prosthetist performs measurements, color shading to match the contralateral hand, and documents limb dimensions and functional needs. The patient requires a replacement restoration glove after wear or loss, and the visit includes fitting, minor adjustments, and patient education on donning, doffing, and care. Typical workflow: referral from a hand surgeon or burn clinic, preauthorization with the insurer, orthotist/prosthetist measurement visit, fabrication by a certified manufacturer, in-clinic fitting of the replacement glove, and billing using L6915 for the hand restoration (shading and measurements included), with possible additional charges for expedited shipping or advanced materials documented separately.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier / default	Use when no specific modifier applies and the service is billed as standard.
`11`	Primary/standalone service

HCPCS L5722: Exoskeletal Knee-Shin Addition, Pneumatic Swing with Friction Stance

HCPCS-L5979-LOWER-EXTREMITY-PROSTHESIS-MULTI-AXIAL-ANKLE-DYNAMIC-FOOT

HCPCS L5979: Lower Extremity Prosthesis, Multi-Axial Ankle with Dynamic Response Foot

HCPCS-L5970-SACH-FOOT-EXTERNAL-KEEL-PROSTHESIS

HCPCS L5970: Lower Extremity Prosthesis Foot, External Keel SACH

HCPCS-L7190-ELECTRONIC-ELBOW-ADOLESCENT-MYOELECTRIC

HCPCS L7190: Electronic Myoelectric Elbow Prosthesis, Adolescent

HCPCS-L7181-ELECTRONIC-ELBOW-MICROPROCESSOR-CONTROL

HCPCS L7181: Electronic Elbow with Microprocessor Simultaneous Control of Elbow and Terminal Device

HCPCS-L5724-EXOSKELETAL-KNEE-SHIN-FLUID-SWING-PHASE-CONTROL

HCPCS L5724: Exoskeletal Knee-Shin System with Fluid Swing Phase Control

HCPCS-L5010-PARTIAL-FOOT-MOLDED-SOCKET-ANKLE-HEIGHT-TOE-FILLER

HCPCS L5010: Partial Foot Molded Socket, Ankle Height, with Toe Filler

HCPCS-L6628-UPPER-EXTREMITY-QUICK-DISCONNECT-HOOK-ADAPTER

HCPCS L6628: Upper Extremity Quick-Disconnect Hook Adapter

HCPCS-L8659-INTERPHALANGEAL-FINGER-JOINT-REPLACEMENT-METAL-CERAMIC

HCPCS L8659: Interphalangeal Finger Joint Replacement, Metal/Ceramic

HCPCS-L8300-TRUSS-SINGLE-STANDARD-PAD

HCPCS L8300: Truss, Single With Standard Pad

Showing 1–10 of 472

Taxonomy Code	Specialty	Notes
`384000000X`	Prosthetist/Orthotist	Primary providers who measure, fit, and order custom restoration gloves.
`207RG0100X`	Hand Surgeon (Orthopedic)	Referring specialty for surgical sequelae, contracture release, or complex hand reconstruction cases.
`207T00000X`	Occupational Therapist	Provides training in use, care, and functional integration of the restoration glove.
`174500000X`	Certified Prosthetist/Orthotist Technician	Technical fabrication and color shading coordination with the manufacturer.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`T20.21XA`	Burn of second degree of right wrist and hand, initial encounter	Burns of the hand commonly result in scarring and disfigurement that prompt use of restoration gloves.
`T20.22XA`	Burn of second degree of left wrist and hand, initial encounter	Same relevance for the contralateral or left hand.
`M24.4`	Contracture of joint	Hand contractures after injury or surgery may necessitate custom restoration gloves to improve cosmesis and function.
`S61.411A`	Complete traumatic amputation of right hand at wrist level, initial encounter	Post-amputation patients may use restoration gloves for cosmesis over residual limbs.
`L90.5`	Scar conditions and fibrosis of skin	Significant scarring of the hand that affects appearance and function leads to demand for custom restoration gloves.
`M79.641`	Pain in right hand	Pain related to hand injury or prosthetic use can influence fitting and adjustment needs.
`Z48.02`	Encounter for change or removal of surgical dressing	Follow-up encounters after surgical procedures may include evaluation for prosthetic/restoration devices.
`Z46.6`	Encounter for fitting and adjustment of intracorporeal device	General code to indicate encounters for fitting/adjustment of prosthetic/restorative devices.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97760`	Orthotic management and training, initial encounter	Used when an orthotist or therapist provides initial training and fitting for the replacement restoration glove.
`97763`	Orthotic/prosthetic management for follow-up	Used for subsequent adjustments, checkouts, or patient education visits related to the glove.
`99070`	Supplies and materials (medical)	Billed when non-covered supplies or additional materials (e.g., specialized liners, adhesives) are provided with the glove.
`99080`	Additional documentation or forms (payer specific)	Used when insurers require supplemental documentation submissions for prior authorization or appeals.
`S1040`	Replacement of hand prosthesis (HCPCS Level II — example, payer-specific)	May be used by some payers as an alternative or supplemental code in conjunction with `L6915` when replacement reporting is required.

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