Summary & Overview
HCPCS L6935: Below-Elbow Myoelectric Prosthesis, Self-Suspended
HCPCS Level II code L6935 identifies a below-elbow, externally powered myoelectric prosthesis with a self-suspended inner socket, removable forearm shell, electrodes and cables, two batteries and one charger, and myoelectronic control of the terminal device. This code captures a bundled prosthetic device and associated components commonly used for transradial amputees seeking powered myoelectric terminal function. Nationally, such devices are significant for functional restoration, influencing device access, coverage policy, and durable medical equipment spending.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides an overview of payment benchmarks, coding and billing considerations, common modifier usage, and the clinical context for device selection and fitting. Readers will gain clarity on what L6935 represents, typical service settings where the device is provided, and the elements included in the description that affect billing and coverage determination. The report also outlines areas where policy updates and payer-specific coverage rules commonly affect authorization and reimbursement, and highlights practical considerations for documentation and claims submission. Data not available in the input is noted where payer-specific rates, associated taxonomies, and ICD-10 pairings would normally appear.
Billing Code Overview
HCPCS Level II code L6935 describes a below-elbow, externally powered myoelectric prosthetic system with a self-suspended inner socket and a removable forearm shell. The device package includes electrodes, cables, two batteries and one charger, and myoelectronic control of the terminal device; the description references an Otto Bock or equivalent product.
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Service type: Prosthetic upper-limb device provision, fitting, and delivery of an externally powered myoelectric terminal device
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Typical site of service: Prosthetics and orthotics clinic, outpatient rehabilitation facility, or specialized prosthetic vendor setting
Clinical & Coding Specifications
Clinical Context
A 45-year-old right-handed male veteran presents to a prosthetics clinic after a traumatic transradial (below-elbow) amputation of the dominant limb following an industrial accident. The patient reports good residual limb healing, intact skin coverage, and preserved muscle contractions in the residual forearm allowing for myoelectric control. The interdisciplinary workflow includes an initial prosthetic evaluation by a certified prosthetist and physiatrist, baseline wound and residual-limb assessment, occupational therapy for functional goals, surface electromyographic (EMG) site testing to identify viable muscle sites for myoelectric electrodes, casting or digital scanning for a self-suspended inner socket and removable forearm shell, fabrication of an external power myoelectric prosthesis (including two batteries and one charger), programming of myoelectronic control of the terminal device, and iterative fitting sessions for socket comfort and device calibration. Follow-up visits include training with an occupational therapist for activities of daily living, routine battery and electronics checks, and periodic maintenance or component replacement. Typical site of service is an outpatient prosthetics clinic or specialized orthotics and prosthetics facility. This device is indicated for patients requiring powered prehension with myoelectric control of a terminal device when residual musculature can provide reliable control signals.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when the prosthesis is fabricated for the left upper extremity |