L6925 Wrist-Disarticulation | HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS L6925: Wrist-Disarticulation Powered Prosthesis, Myoelectronic Control

HCPCS Level II code L6925 identifies an externally powered wrist-disarticulation prosthesis with a self-suspended inner socket, removable forearm shell, electrodes and cables (e.g., Otto Bock or equal), two batteries, one charger, and myoelectronic control of the terminal device. This code is used to bill for the provision and fitting of a powered upper-limb prosthetic system for patients with wrist-level amputation, representing a specialized durable medical equipment and prosthetics service nationally.

Key payers in national coverage considerations include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for powered wrist-disarticulation prostheses, typical sites of service, and the components bundled under this HCPCS Level II code. The publication outlines common billing and coding themes, benchmarks for utilization and device composition, and policy considerations relevant to payer coverage determinations and prior authorization practices. Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes will be noted where appropriate.

This summary provides clinicians, billing staff, and policy analysts with a concise reference to the code’s clinical purpose, typical care settings, and the types of equipment and controls included under L6925. It is intended for a national audience considering reimbursement and clinical integration of myoelectric-powered wrist prostheses.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareL6925HCPCS Level IIpowered prosthesisupper-limb prostheticsmyoelectric controldurable medical equipmentprosthetics billingwrist disarticulation

Billing Code Overview

HCPCS Level II code L6925 describes a wrist disarticulation external power prosthesis with a self-suspended inner socket and removable forearm shell. The device package includes electrodes and cables (brand example: Otto Bock or equal), two batteries, one charger, and myoelectronic control of the terminal device. The description indicates a powered upper-limb prosthetic solution designed for wrist-level amputation.

Service Type: Prosthetic device provision and fitting, powered upper-limb prosthesis

Typical Site of Service: Prosthetics and orthotics clinic, outpatient rehabilitation facility, or durable medical equipment supplier with prosthetics services

Clinical & Coding Specifications

Clinical Context

A 42-year-old male with a transradial limb loss at the wrist level from a traumatic work-related injury is evaluated by a certified prosthetist and an orthopedic hand surgeon for fitting of a myoelectric prosthesis. The device described by billing code L6925 is an external power wrist-disarticulation style prosthesis with a self-suspended inner socket, removable forearm shell, integrated electrodes and cables, two batteries and one charger, and myoelectronic control of the terminal device. The clinical workflow includes: initial multidisciplinary assessment (prosthetics, occupational therapy, and surgery as needed); fabrication of a diagnostic socket; alignment and training sessions to identify optimal myoelectric signal sites; mapping and programming of the myoelectric controller; delivery and fit testing of the definitive device; patient education on battery management and maintenance; and scheduled follow-up visits for adjustments, socket relining, and functional outcome assessment. Typical settings for evaluation, fitting, and training include outpatient prosthetics clinics, hospital-based orthotics and prosthetics departments, and specialized rehabilitation centers. Documentation should include the prosthetic order, clinical justification for a powered myoelectric terminal device (functional deficits, goals for activities of daily living), records of myoelectric site testing, training notes, and device serial numbers for the batteries and controller.

Coding Specifications

Modifier	Description	When to Use
`26`

HCPCS L7009: Electric/Myoelectric Adult Prosthetic Hook

HCPCS-L8622-ALKALINE-BATTERY-COCHLEAR-IMPLANT-REPLACEMENT

HCPCS L8622: Alkaline Battery for Cochlear Implant, Replacement

HCPCS-L7364-TWELVE-VOLT-BATTERY-DURABLE-MEDICAL-EQUIPMENT

HCPCS L7364: Twelve Volt Battery, Durable Medical Equipment

HCPCS-L5714-EXOSKELETAL-KNEE-SHIN-VARIABLE-FRICTION-SWING-CONTROL

HCPCS L5714: Exoskeletal Knee-Shin, Single Axis, Variable Friction Swing Phase Control

HCPCS-L6384-SHOULDER-DISARTICULATION-INITIAL-RIGID-DRESSING-FITTING

HCPCS Level II L6384: Initial Rigid Dressing for Shoulder Disarticulation

HCPCS-L7401-UPPER-EXTREMITY-PROSTHESIS-ABOVE-ELBOW-ULTRALIGHT

HCPCS L7401: Addition to Above-Elbow Prosthesis, Ultralight Material

HCPCS-L5686-LOWER-EXTREMITY-BELOW-KNEE-EXTENSION-CONTROL

HCPCS L5686: Addition to Below-Knee Lower Extremity, Extension Control

HCPCS-L5969-POWER-ASSIST-ANKLE-FOOT-SYSTEM-ADDITION

HCPCS L5969: Addition of Power-Assist to Endoskeletal Ankle-Foot System

HCPCS-L5992-LOWER-EXTREMITY-PROSTHESIS-FOOT-SHELL-SACH-REPLACEMENT

HCPCS L5992: Lower-Extremity Prosthesis Foot Shell (SACH) Replacement

HCPCS-L8690-AUDITORY-OSSEOINTEGRATED-DEVICE-IMPLANTABLE-HEARING-PROSTHESIS

HCPCS L8690: Auditory Osseointegrated Device, All Components

Showing 1–10 of 472

Taxonomy Code	Specialty	Notes
`252S00000X`	Prosthetics/Orthotics	Primary providers who fabricate and fit upper-extremity powered prostheses.
`207W00000X`	Orthopedic Surgery	Surgeons managing residual limb, revisions, and surgical clearance for prosthetic fitting.
`332600000X`	Occupational Therapy	Clinicians responsible for training, myoelectric signal acquisition, and ADL training.
`207L00000X`	Hand Surgery	Specialists in complex upper-extremity amputation care and functional optimization.
`225100000X`	Physical Medicine & Rehabilitation	Physicians overseeing rehab plans and functional goals for prosthetic use.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S48.111A`	Strain of muscle, fascia and tendon at forearm level, right upper arm, initial encounter	Relevant when traumatic injury precipitates amputation at or near the wrist level leading to prosthetic prescription.
`S48.112A`	Strain of muscle, fascia and tendon at forearm level, left upper arm, initial encounter	Alternative laterality for traumatic injuries resulting in upper-extremity loss and need for myoelectric prosthesis.
`S58.10XA`	Unspecified injury of muscle and tendon at forearm level, initial encounter	Used for complex forearm injuries evolving into surgical amputation and prosthetic planning.
`T87.89XA`	Complications of other transplanted organs and tissues, initial encounter	Included when there are postoperative complications of limb salvage that lead to revision and final prosthetic fitting (less common).
`Z89.611`	Acquired absence of right arm below elbow	Directly relevant to prosthetic prescription at the wrist/disarticulation level for the right side.
`Z89.612`	Acquired absence of left arm below elbow	Directly relevant to prosthetic prescription at the wrist/disarticulation level for the left side.
`G54.1`	Brachial plexus lesions, affecting upper limb function	Relevant when neurologic deficits necessitate a powered myoelectric device to restore function.
`M79.641`	Pain in right hand	Used as a symptom code when residual-limb pain impacts fitting and prosthetic tolerance.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97760`	Orthotic(s) management and training, upper extremity, initial; includes assessment and fitting, training in use of device	Often used by occupational therapists for initial training and follow-up after delivery of a myoelectric prosthesis.
`97761`	Prosthetic training, upper limb, subsequent encounters	Used for ongoing training sessions after the initial fitting and device delivery.
`97763`	Orthotic/prosthetic management and training, upper extremity, each additional session	Billed for additional training sessions to improve function with the powered terminal device.
`96127`	Brief emotional/behavioral assessment (e.g., PHQ-9)	Sometimes used to document brief standardized assessments of mood which can impact prosthetic rehabilitation adherence.
`99070`	Consumable supplies used in the provision of services, e.g., batteries, adhesives (if not included in device supply)	Used when replacement batteries, adhesives, or consumable items are supplied outside the prosthetic device allowance.
`L-codes`	HCPCS Level II prosthetic supply codes	Other L-codes may be used for replacement components, chargers, or replacement batteries not included in the initial `L6925` supply.

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